scholarly journals Modeling the Impact of COVID-19 on Retina Clinic Performance

2021 ◽  
Author(s):  
Karan Sethi ◽  
Emily S. Levine ◽  
Shiyoung Roh ◽  
Jeffrey L. Marx ◽  
David J Ramsey
Keyword(s):  
Patient Satisfaction ◽  
Patient Flow ◽  
Wait Time ◽  
High Volume ◽  
Clinical Encounter ◽  
Operational Performance ◽  
Discrete Events ◽  
Flow Through ◽  
The Impact ◽  
Total Visit

Abstract Background: COVID-19, a highly contagious respiratory virus, presents unique challenges to ophthalmology practice as a high-volume, office-based specialty. In response to the COVID-19 pandemic, many operational changes were adopted in our ophthalmology clinic to enhance patient and provider safety while maintaining necessary clinical operations. The aim of this study was to evaluate how measures adopted during the pandemic period affected retina clinic performance and patient satisfaction, and to model future clinic flow to predict operational performance under conditions of increasing patient and provider volumes. Methods: Timestamps were extracted from the electronic medical records of in-person retina encounters from March 15 to May 15, 2020 and compared with the same period in 2019 to assess patient flow through the clinical encounter. Patient satisfaction was evaluated by Press Ganey patient experience surveys obtained from randomly selected outpatient encounters. A discrete-events simulation was designed to model the clinic with COVID-era restrictions to assess operational performance under conditions of increasing patient and provider volumes.Results: Retina clinic volume declined by 62% during the COVID-19 health emergency. Average check-in-to-technician time declined 79%, total visit length declined by 46%, and time in the provider phase of care declined 53%. Of note, patient satisfaction regarding access nearly doubled during the COVID-period compared with the prior year (p < 0.0001), while satisfaction with overall care and safety remained high during both periods. A model incorporating COVID-related changes demonstrated that wait time before rooming reached levels similar to the pre-COVID era by 30 patients per provider in a 1-provider model and 25 patients-per-provider in a 2-provider model (p < 0.001). Capacity to maintain distancing between patients was exceeded only in the two 2-provider model above 25 patients-per-provider.Conclusions: Clinic throughput was optimized in response to the COVID-19 health emergency. Modeling these clinic changes can help plan for eventual volume increases in the setting of limits imposed in the COVID-era.

scholarly journals Modeling the impact of COVID-19 on Retina Clinic Performance

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Karan Sethi ◽  
Emily S. Levine ◽  
Shiyoung Roh ◽  
Jeffrey L. Marx ◽  
David J. Ramsey
Keyword(s):  
Patient Satisfaction ◽  
Patient Flow ◽  
Wait Time ◽  
High Volume ◽  
Clinical Encounter ◽  
Operational Performance ◽  
Discrete Events ◽  
Flow Through ◽  
The Impact ◽  
Total Visit

Abstract Background COVID-19, a highly contagious respiratory virus, presents unique challenges to ophthalmology practice as a high-volume, office-based specialty. In response to the COVID-19 pandemic, many operational changes were adopted in our ophthalmology clinic to enhance patient and provider safety while maintaining necessary clinical operations. The aim of this study was to evaluate how measures adopted during the pandemic period affected retina clinic performance and patient satisfaction, and to model future clinic flow to predict operational performance under conditions of increasing patient and provider volumes. Methods Clinic event timestamps and demographics were extracted from the electronic medical records of in-person retina encounters from March 15 to May 15, 2020 and compared with the same period in 2019 to assess patient flow through the clinical encounter. Patient satisfaction was evaluated by Press Ganey patient experience surveys obtained from randomly selected outpatient encounters. A discrete-events simulation was designed to model the clinic with COVID-era restrictions to assess operational performance under conditions of increasing patient and provider volumes. Results Retina clinic volume declined by 62 % during the COVID-19 health emergency. Average check-in-to-technician time declined 79 %, total visit length declined by 46 %, and time in the provider phase of care declined 53 %. Patient satisfaction regarding access nearly doubled during the COVID-period compared with the prior year (p < 0.0001), while satisfaction with overall care and safety remained high during both periods. A model incorporating COVID-related changes demonstrated that wait time before rooming reached levels similar to the pre-COVID era by 30 patients-per-provider in a 1-provider model and 25 patients-per-provider in a 2-provider model (p < 0.001). Capacity to maintain distancing between patients was exceeded only in the two 2-provider model above 25 patients-per-provider. Conclusions Clinic throughput was optimized in response to the COVID-19 health emergency. Modeling these clinic changes can help plan for eventual volume increases in the setting of limits imposed in the COVID-era.

scholarly journals Improving patient flow and timeliness in the diagnosis and management of breast abnormalities: the impact of a rapid diagnostic unit

2016 ◽  
Vol 23 (3) ◽  
pp. 260 ◽  
Author(s):  
J.M. Racz ◽  
C.M.B. Holloway ◽  
W. Huang ◽  
N.J. Look Hong
Keyword(s):  
Care Delivery ◽  
Patient Flow ◽  
Wait Time ◽  
Definitive Treatment ◽  
Wait Times ◽  
Fisher Exact Test ◽  
Patient Anxiety ◽  
Diagnostic Unit ◽  
Clinical Investigations ◽  
The Impact

Background Efforts to streamline the diagnosis and treatment of breast abnormalities are necessary to limit patient anxiety and expedite care. In the present study, we examined the effect of a rapid diagnostic unit (RDU) on wait times to clinical investigations and definitive treatment.Methods A retrospective before–after series, each considering a 1-year period, examined consecutive patients with suspicious breast lesions before and after initiation of the RDU. Patient consultations, clinical investigations, and lesion characteristics were captured from time of patient referral to initiation of definitive treatment. Outcomes included time (days) to clinical investigations, to delivery of diagnosis, and to management. Groups were compared using the Fisher exact test or Student t-test.Results The non-RDU group included 287 patients with 164 invasive breast carcinomas. The RDU group included 260 patients with 154 invasive carcinomas. The RDU patients had more single visits for biopsy (92% RDU vs. 78% non-RDU, p < 0.0001). The RDU group also had a significantly shorter wait time from initial consultation to delivery of diagnosis (mean: 2.1 days vs. 16.7 days, p = 0.0001) and a greater chance of receiving neoadjuvant chemotherapy (37% vs. 24%, p = 0.0106). Overall time from referral to management remained statistically unchanged (mean: 53 days with the RDU vs. 50 days without the RDU, p = 0.3806).Conclusions Introduction of a RDU appears to reduce wait times to definitive diagnosis, but not to treatment initiation, suggesting that obstacles to care delivery can occur at several points along the diagnostic trajectory. Multipronged efforts to reduce system-related delays to definitive treatment are needed.

scholarly journals Dietitian first gastroenterology clinic: an initiative to reduce wait lists and wait times for gastroenterology outpatients in a tertiary hospital service

2018 ◽  
Vol 10 (3) ◽  
pp. 229-235 ◽  
Author(s):  
Rumbidzai N Mutsekwa ◽  
Russell Canavan ◽  
Anthony Whitfield ◽  
Alan Spencer ◽  
Rebecca L Angus
Keyword(s):  
Patient Flow ◽  
Wait Time ◽  
Tertiary Hospital ◽  
University Hospital ◽  
Wait Times ◽  
Activity Data ◽  
Patient Journey ◽  
Service Activity ◽  
High Level ◽  
The Impact

ObjectiveThe demand for outpatient gastroenterology medical specialist consultations is above what can be met within budgetary and staffing constraints. This study describes the establishment of a dietitian first gastroenterology clinic to address this issue, the patient journey and its impact on wait lists and wait times in a tertiary gastroenterology service.DesignA dietitian first gastroenterology clinic model was developed and a mixed-methods approach used to evaluate the impact of the service over a 21-month period.SettingGold Coast University Hospital, Queensland, Australia (a public tertiary hospital).Patients658 patients were triaged to the clinic between June 2016 and March 2018.InterventionA dietitian first gastroenterology clinic for low-risk gastroenterology patients.Main outcome measuresWe examined demographic, referral, wait list, wait time and service activity data, patient satisfaction and patient journey.ResultsAt the time of audit, 399 new (67.9% female) and 307 review patients had been seen. Wait times for eligible patients reduced from 280 to 66 days and the percentage of those in breach of their recommended wait times reduced from 95% to zero. The average time from referral to discharge was 117.8 days with an average of 2.4 occasions of service. 277 patients (69.4%) had been discharged to the care of their general practitioner and 43 patients (10.7%) had an expedited specialist medical review. Patient surveys indicated a high level of satisfaction.ConclusionA dietitian first gastroenterology model of care helps improve patient flow, reduces wait times and may be useful elsewhere to address outpatient gastroenterology service pressures.

scholarly journals The impact of computerized provider order entry on emergency department flow

CJEM ◽  
2016 ◽  
Vol 18 (4) ◽  
pp. 264-269 ◽  
Author(s):  
Andrew Gray ◽  
Christopher M.B. Fernandes ◽  
Kristine Van Aarsen ◽  
Melanie Columbus
Keyword(s):  
Emergency Department ◽  
Patient Safety ◽  
Improve Patient Safety ◽  
Patient Flow ◽  
Wait Time ◽  
Order Entry ◽  
Computerized Provider Order Entry ◽  
Left Without Being Seen ◽  
Before And After ◽  
The Impact

AbstractObjectivesComputerized provider order entry (CPOE) has been established as a method to improve patient safety by avoiding medication errors; however, its effect on emergency department (ED) flow remains undefined. We examined the impact of CPOE implementation on three measures of ED throughput: wait time (WT), length of stay (LOS), and the proportion of patients that left without being seen (LWBS).MethodsWe conducted a retrospective cohort study of all ED patients of 18 years and older presenting to London Health Sciences Centre during July and August 2013 and 2014, before and after implementation of a CPOE system. The three primary variables were compared between time periods. Subgroup analyses were also conducted within each Canadian Triage and Acuity Scale (CTAS) level (1–5) individually, as well as for admitted patients only.ResultsA significant increase in WT of 5 minutes (p=0.036) and LOS of 10 minutes (p=0.001), and an increase in LWBS from 7.2% to 8.1% (p=0.002) was seen after CPOE implementation. Admitted patients’ LOS increased by 63 minutes (p<0.001), the WT of CTAS 3 and 5 patients increased by 6 minutes (p=0.001) and 39 minutes (p=0.005), and LWBS proportion increased significantly for CTAS 3–5 patients, from 24.3% to 42.0% (p<0.001) for CTAS 5 patients specifically.ConclusionsCPOE implementation detrimentally impacted all patient flow throughput measures that we examined. The most striking clinically relevant result was the increase in LOS of 63 minutes for admitted patients. This raises the question as to whether the potential detrimental effects to patient safety of CPOE implementation outweigh its benefits.

Ambulatory redesign: Strategies for quality improvement in patient care.

2016 ◽  
Vol 34 (7_suppl) ◽  
pp. 85-85
Author(s):  
Naralys Estevez Sinanis ◽  
Catherine A. Lyons ◽  
Nancy Smith ◽  
Maureen McGlennon ◽  
Terri L. Parker ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Patient Flow ◽  
Wait Time ◽  
Turnaround Time ◽  
Practice Volume ◽  
Multidisciplinary Teams ◽  
Management Support ◽  
Provider Education ◽  
Defect Rate ◽  
Academic Medical

85 Background: Growing outpatient volume poses patient flow challenges, making it difficult to accommodate the complexities of academic medical practice. Volume increases create operational inefficiencies like delays in lab turnaround time (TAT) and limited rooming capacity resulting in delays in patient access and reduced provider productivity. These bottlenecks negatively impact patient satisfaction. Methods: Four multidisciplinary teams assessed barriers to patient flow in the lab, rooming and scheduling process. We sought to maximize the Advanced Practice Provider (APP) role within clinical programs. Each team was led jointly by an MD and RN and included subject matter experts, advisors and facilitators. The groups met regularly for 2 months to evaluate operational data, national benchmarks and surveyed staff. Monthly progress was presented during the Ambulatory Clinic Committee (ACC) meetings. Number of labs not completed on time, wait-time and APP visit volume were tracked. Results: Recommendations included provider education on lab order process, purchasing a second instrument for chemistries, APP independent visits standards, and realistic scheduling times. Preliminary findings indicate that the lab reduced their average TAT defect rate by 52.3% (CBC) and 76.1% (CMP) compared to January 2014 (baseline) and January 2015 (post implementation). This difference was statistically significant at a 95% CI, with p < .001 for both CBCs and CMPs. In addition, APP total visit volume increased by 81% from FY 2014 to FY 2015. Finally, the overall Press-Ganey mean in patient satisfaction with physician wait time increased from 81.7 to 82.7 (2014 vs. 2015). Conclusions: Multidisciplinary teams recommended valuable process improvement changes to reduce the TAT in the lab and to promote that APPs work within the full scope of their license. Implementation requires extensive project management support and continuous tracking to evaluate outcomes. Opportunities exist to maximize space and room utilization and optimize the scheduling process as the outpatient volume continues to increase.

Implementation of interdisciplinary neurosurgery morning huddle: cost-effectiveness and increased patient satisfaction

2018 ◽  
Vol 128 (1) ◽  
pp. 258-261 ◽  
Author(s):  
Alvin Y. Chan ◽  
Sumeet Vadera
Keyword(s):  
Patient Satisfaction ◽  
Patient Care ◽  
Direct Cost ◽  
Patient Flow ◽  
Hospital Costs ◽  
Significant Difference ◽  
Before And After ◽  
Flow Through ◽  
Step Down ◽  
Strongly Agree

OBJECTIVEMorning discharge huddles consist of multiple members of the inpatient care team and are used to improve communication and patient care and to facilitate patient flow through the hospital. However, the effect of huddles on hospital costs and patient satisfaction has not been clearly elucidated. The authors investigated how a neurosurgeryled interdisciplinary daily morning huddle affected various costs of patient care and patient satisfaction.METHODSHuddles were conducted at 8:30 am Monday through Friday, and lasted approximately 30 minutes. The authors retrospectively looked at the average monthly costs per patient for a variety of variables (e.g., average ICU days, average step-down days, average direct cost, average laboratory costs, average pharmacy costs, hospital ratings, and hospital recommendations) and compared the results from before and after implementation of the huddle.RESULTSThere was a significant decrease in the number of ICU days, average laboratory costs, and average pharmacy costs per patient after the huddle was implemented; decreased laboratory and pharmacy costs produced $1,408,047.66 in savings. There was no significant difference found for the average direct cost. The percentage of patients who rated the hospital as a 9 or 10 significantly increased. The percentage who answered “strongly agree” when asked whether they would recommend the hospital also significantly increased.CONCLUSIONSA short morning huddle consisting of key members of the inpatient team may result in substantial hospital savings derived from reduced ICU days and laboratory and pharmacy costs as well as increased patient satisfaction.

scholarly journals P.017 Results of a Pilot feasibility study to develop reduce wait times strategy in the evaluation of children with new onset epilepsy

2018 ◽  
Vol 45 (s2) ◽  
pp. S20-S20
Author(s):  
JA Mailo ◽  
M Diebold ◽  
E Mazza ◽  
P Guertjens ◽  
H Gangam ◽  
...  
Keyword(s):  
Patient Flow ◽  
Waiting Times ◽  
Wait Time ◽  
Febrile Seizures ◽  
Limiting Factors ◽  
Wait Times ◽  
Timely Access ◽  
Flow Through ◽  
Pilot Feasibility Study ◽  
New Onset

Background: The goal was to understand factors leading to prolonged wait times for neurological assessment of children with new onset seizures. A second objective was to develop an innovative approach to patient flow through and achieve a reduction in waiting times utilizing limited resources.Methods:Audit of the referrals, flow through, wait timesIdentification of bottlenecksDevelopment of triaging strategy:Suspected Febrile seizures and non-epileptic events;Suspected benign and absence epilepsies;Suspected other Focal epilepsies, generalized epilepsies, epilepsy under 2 yearsInitiation of early telephone contact and supportDevelopment of a ketogenic dietResults: Using a triaging strategy and focusing on timely access to investigations, wait times for clinic evaluations were shortened despite larger numbers of referrals (mean wait time reductions from 179 to 91 days). Limiting factors such increase in referral numbers, attrition in support staff, interfered with sustainability of reduced wait times achieved in the initial phase of the program. Conclusions: This pilot study highlights the effectiveness of an innovative triaging strategy and improvements in patient flow through in achieving the goals of reduction in wait times for clinical evaluation and timely investigations to improve care for children with new onset seizures. Insights into limitations of such strategies and factors determining sustainability are discussed.

110 Neurosurgery Morning Huddle Reduces Costs and Increases Patient Satisfaction

Neurosurgery ◽  
2017 ◽  
Vol 64 (CN_suppl_1) ◽  
pp. 222-223
Author(s):  
Alvin Chan ◽  
Sumeet Vadera
Keyword(s):  
Patient Satisfaction ◽  
Patient Care ◽  
Direct Cost ◽  
Inpatient Care ◽  
Patient Flow ◽  
Hospital Costs ◽  
Team Members ◽  
Before And After ◽  
Flow Through ◽  
Strongly Agree

Abstract INTRODUCTION Morning discharge huddles, consisting of inpatient care team members, improve communication and patient care, facilitating patient flow through the hospital. However, how huddles affect hospital costs and patient satisfaction is unclear. The aim was to investigate how a neurosurgery-led interdisciplinary daily morning huddle affected different costs of patient care and patient satisfaction. METHODS Data was collected retrospectively for average ICU days, average stepdown days, average direct cost, average laboratory costs, average pharmacy costs, hospital ratings, hospital recommendations. Then the data before and after implantation of the huddle were compared. RESULTS >There was a significant decrease in the number of ICU days, average laboratory costs, and average pharmacy costs per patient after the huddle was implemented (all P < 0.05), resulting in an estimated $1408,047.66 in savings. The percentage of patients who rated our hospital as a “9 or 10” significantly increased (P < 0.05). The percentage who answered “strongly agree” when asked whether they would recommend the hospital also significantly increased (P < 0.05). There was no difference for average direct cost. CONCLUSION Implementation of a morning huddle may result in significant hospital savings while simultaneously increasing patient satisfaction.

scholarly journals Improving Patient Experience of Wait Times and Courtesy Through Electronic Sign-in and Notification in the Phlebotomy Clinic

2019 ◽  
Vol 144 (6) ◽  
pp. 769-775
Author(s):  
Vincent Le ◽  
Elizabeth A. Wagar ◽  
Ron A. Phipps ◽  
Robert E. Del Guidice ◽  
Han Le ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Patient Experience ◽  
Patient Flow ◽  
Wait Time ◽  
Satisfaction Score ◽  
Wait Times ◽  
Notification System ◽  
The Mean ◽  
Patients Experience ◽  
And Training

Context.— The phlebotomy clinic, which sees on average 900 patients a day, was faced with issues of congestion and noise due to inefficient workflow and processes. The staff called each patient name for his or her turn, and patients were unsure of wait time and position in line. These factors led to unfavorable patient satisfaction regarding wait times and courtesy of the staff. Objective.— To improve patients' experience of wait times and courtesy in the phlebotomy clinic through an electronic sign-in and notification system, redesign of the area, and training of employees. Design.— An electronic sign-in and notification system was implemented in the phlebotomy clinic. Several sign-in stations and whiteboard wall monitors were installed in the clinic, along with a redesign of the patient flow. A Press Ganey survey was given to patients after their visit which included 3 questions related to wait times, courtesy, and information about delays, respectively. The mean responses for each month between March 2016 and December 2018 were aggregated and compared for each measure. Results.— Overall, wait time saw a 7.7% increase in satisfaction score, and courtesy saw a 1.0% increase in satisfaction score during the course of the several interventions that were introduced. The operational efficiency of the clinic also saw a veritable increase because the percent of patients processed within 20 minutes increased by 27%, from 62% (8212 of 13 245 blood draws) to 89% (11 703 of 13 143 blood draws). Conclusions.— The interventions implemented proved to increase the patient satisfaction in each of the measures. The electronic sign-in and whiteboards provided valuable information to both patients and staff.

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