Reducing Waiting Time in the General Pediatric Clinic at Al Wakra Hospital, Qatar

Background: Waiting times for clinic appointments constitute a key indicator of an outpatient department performance for access to care and patient satisfaction. This is particularly relevant for pediatric population. The Ministry of Public Health in Qatar set a waiting time of 28 days for patients to get new appointment in General Outpatient Department (GOPD). The current average waiting time to get a new appointment in the general pediatric clinic (GPC) at AWH is 57 days. Aim: Decrease the average waiting time to get a new clinic appointment from 57 days to 28 days by the end of December 2018, and to meet the national targets set by the Ministry of Public Health. Methodology: This is a Quality Improvement (QI) project using the Model for Improvement (MFI). The MFI framework is designed to support organizations answering fundamental questions before agreeing on drivers for change. The implementation of change was be facilitated by the Plan-Do-Study-Act (PDSA) cycles methodology. The QI project team performed a root cause analysis using the Ishikawa diagram and identified the key contributing factors to the long waiting times to get a new appointment. Twenty-seven PDSA cycle ramps were designed with support of predictive tool to test innovative changes in current operational processes in an attempt to improve waiting time in the general pediatric clinic at Al Wakra Hospital. Results: The monthly average number of referrals for GPC increased by 200% between the pre and post implementation periods. The average triage waiting time improved from 6 to 2.6 days in 2018 and the average become 1 day in 2019. Post-implementation the average waiting time for patients to get new appointment improved from 57 days to 28 days in 2018 and the average waiting time improved to 16 days in 2019. Conclusion: The quality improvement project for the AWH general pediatric clinic demonstrates significant improvement in waiting times for new appointments, the recommendation for the hospital leadership would be to rollout the improvement methodology to other clinics that suffer from similar challenges.

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Reducing the waiting time to initiation of infertility treatment at a tertiary care centre in India

BMJ Open Quality ◽

10.1136/bmjoq-2020-000975 ◽

2020 ◽

Vol 9 (4) ◽

pp. e000975

Author(s):

K Aparna Sharma ◽

Anshu Yadav ◽

Chithira Sridhar ◽

Neena Malhotra ◽

Siby Biji ◽

...

Keyword(s):

Quality Improvement ◽

Waiting Time ◽

Waiting Times ◽

Infertility Treatment ◽

Resident Physician ◽

Junior Resident ◽

Improvement Project ◽

Waiting Period ◽

Average Waiting Time ◽

Mean Waiting Time

BackgroundIn a low-resource and high-volume setting, it is often felt that patient care cannot be improved within the limitations of existing infrastructure and resources. However, the use of a systematic problem-solving method can bring about significant improvement even in these settings.AimTo decrease the mean waiting time from first visit to initiation of infertility treatment by 70% within 4 weeks (1–30 June 2019) for patients coming to the gynaecological outpatient department (OPD).MethodsWe constructed a multidisciplinary quality improvement team consisting of an academic consultant, a senior resident physician, a junior resident physician and a nurse to address the problem of long waiting times to initiation of fertility treatment. We collected baseline data from 10 consecutive women presenting to gynaecological OPD with complaints of infertility by calculating the time between their first visit to the facility and the day of performance of hysterosalpingography (HSG). The average waiting time was found to be 6 months and 25 days (mean=6.85 months; 3.5–10 months). The team used process flow diagrams and fishbone analysis to identify various causes of these long waiting times. The main reason for the delay in starting infertility treatment was that the date for HSG was given only after seeing the endometrial aspiration report (ie, after ruling out endometrial tuberculosis as there is a risk of dissemination of tuberculosis during HSG). Also, HSG was done only once a week during a short 2-hour slot in the fluoroscopy room.ResultsAfter the implementation of change ideas, there was significant reduction in the waiting period to starting treatment in patients with infertility. After the first change idea, the average waiting period seen in 10 consecutive patients with infertility reduced to 3.25 months, that is, by 51.8% from baseline within a 2-week interval, and there is shift in the run chart diagram. After the second change idea, the waiting time reduced to 2 months, that is, by 70%, seen in the next 10 consecutive patients with infertility within the next 2 weeks’ time. The results were sustained to the average waiting time of 2 months for 6 months without any additional resources.ConclusionWith a well-organised and conducted quality improvement project and team efforts, the required changes can be brought about in an established conventional healthcare delivery system and improvements can be sustained over a long period of time.

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How does clinical space utilisation impact patient flow?

BMJ Open Quality ◽

10.1136/bmjoq-2018-000542 ◽

2019 ◽

Vol 8 (3) ◽

pp. e000542 ◽

Cited By ~ 1

Author(s):

Alexandra von Guionneau ◽

Charlotte M Burford

Keyword(s):

Quality Improvement ◽

Waiting Time ◽

Primary Outcome ◽

Patient Flow ◽

Waiting Times ◽

Wait Time ◽

Limiting Factor ◽

Electronic Systems ◽

Improvement Project ◽

Medical Wards

BackgroundLong waiting times in accident and emergency (A&E) departments remain one of the largest barriers to the timely assessment of critically unwell patients. In order to reduce the burden on A&Es, some trusts have introduced ambulatory care areas (ACAs) which provide acute assessment for general practitioner referrals. However, ACAs are often based on already busy acute medical wards and the availability of clinical space for clerking patients means that these patients often face long waiting times too. A cheap and sustainable method to reducing waiting times is to evaluate current space utilisation with the view to making use of underutilised workspace. The aim of this quality improvement project was to improve accessibility to pre-existing clinical spaces, and in doing so, reduce waiting times in acute admissions.MethodsData were collected retrospectively from electronic systems and used to establish a baseline wait time from arrival to having blood taken (primary outcome). Quality improvement methods were used to identify potential implementations to reduce waiting time, by increasing access to clinical space, with serial measurements of the primary outcome being used to monitor change.ResultsData were collected over 54 consecutive days. The median wait time increased by 55 min during the project period. However, this difference in waiting time was not deemed significant between the three PDSA cycles (p=0.419, p=0.270 and p=0.350, Mann-Whitney U). Run chart analysis confirmed no significant changes occurred.ConclusionIn acute services, one limiting factor to seeing patients quickly is room availability. Quality improvement projects, such as this, should consider facilitating better use of available space and creating new clinical workspaces. This offers the possibility of reducing waiting times for both staff and patients alike. We recommend future projects focus efforts on integration of their interventions to generate significant improvements.

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EP.WE.727Upper GI Surgery Clinic Referrals; Can We Improve the Patient Experience?

British Journal of Surgery ◽

10.1093/bjs/znab308.088 ◽

2021 ◽

Vol 108 (Supplement_7) ◽

Author(s):

Mohamed Abouelazayem ◽

Raluca Belchita

Keyword(s):

Patient Experience ◽

Waiting Time ◽

Waiting Times ◽

Patient Records ◽

Electronic Patient Records ◽

Post Discharge ◽

Average Waiting Time ◽

Upper Gi

Abstract Aim To review the new referrals to the Upper GI surgery clinic for appropriateness, investigations requested, and waiting times and to identify potential pathways to reduce waiting times and improve the patient experience. Method Patients who attended the UGI clinic over 2 months period were identified. Data were collected from GP referrals and Electronic Patient Records. Follow up, post-discharge appointments, and Did Not Attends were excluded. Data collected included time from referral to first clinic, symptoms, investigations requested, suitability for a pathway, and appropriateness of referral. A first clinic outcome was concluded from reading the GP referral, there were 5 outcomes to choose from; direct to another specialty, discharge back to GP, clinic, surgery, pre-investigate and clinic. Results 147 referrals were analysed. The average waiting time from referral to the first clinic was 51 days (range 7-119 days). 73% of the referrals were GP referrals and 27% from other specialties. The most common referral was for gallstones and the most common 2 outcomes were Pre-investigate and surgery. Conclusion Most of the investigations and outcomes suggested from the project were the same as those from clinic letters. The following pathways can be developed to cut waiting times and costs for the trust:

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Quality Improvement Project: Reduce Waiting Time for Inpatient Spinal Cord Injury Rehabilitation Transfer from Orthopedic and Neurosurgery to Rehabilitation Unit

Archives of Physical Medicine and Rehabilitation ◽

10.1016/j.apmr.2021.07.743 ◽

2021 ◽

Vol 102 (10) ◽

pp. e91

Author(s):

Jing Chen ◽

Sangita Kuparasundram ◽

Siew Yuk Ong ◽

Joy Tan ◽

Audi Fehdurani Bin Mat Sayuti ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Quality Improvement ◽

Waiting Time ◽

Quality Improvement Project ◽

Rehabilitation Unit ◽

Injury Rehabilitation ◽

Improvement Project ◽

Cord Injury

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Improving the waiting times within a hospice breathlessness service

BMJ Open Quality ◽

10.1136/bmjoq-2018-000582 ◽

2019 ◽

Vol 8 (2) ◽

pp. e000582

Author(s):

Caroline Sime ◽

Stuart Milligan ◽

Kevin Donal Rooney

Keyword(s):

Palliative Care ◽

Quality Improvement ◽

Waiting Time ◽

Current System ◽

Waiting Times ◽

Well Being ◽

Common Symptom ◽

Specialist Palliative Care ◽

Published Evidence

BackgroundBreathlessness, a common symptom in advanced disease, is a distressing, complex symptom that can profoundly affect the quality of one’s life. Evidence suggests that specialist palliative care breathlessness intervention services can improve physical well-being, personal coping strategies and quality of life. In the UK, the use of quality improvement methods is well documented in the National Health Service. However, within the independent hospice sector there is a lack of published evidence of using such methods to improve service provision.AimThe aim of this project was to reduce the waiting time from referral to service commencement for a hospice breathlessness service by 40%—from a median of 19.5 to 11.5 working days.MethodsUsing a quality planning and systems thinking approach staff identified barriers and blockages in the current system and undertook plan-do-study-act cycles to test change ideas. The ideas tested included offering home visits to patients on long-term oxygen, using weekly team ‘huddles’, streamlining the internal referral process and reallocating staff resources.ResultsUsing quality improvement methods enabled staff to proactively engage in positive changes to improve the service provided to people living with chronic breathlessness. Offering alternatives to morning appointments; using staff time more efficiently and introducing accurate data collection enabled staff to monitor waiting times in real time. The reduction achieved in the median waiting time from referral to service commencement exceeded the project aim.ConclusionsThis project demonstrates that quality improvement methodologies can be successfully used in a hospice setting to improve waiting times and meet the specific needs of people receiving specialist palliative care.

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Measuring and Analyzing Waiting Time Indicators of Patients’ Admitted in Emergency Department: A Case Study

Global Journal of Health Science ◽

10.5539/gjhs.v8n1p143 ◽

2015 ◽

Vol 8 (1) ◽

pp. 143 ◽

Cited By ~ 6

Author(s):

Saeed Amina ◽

Ahmad Barrati ◽

Jamil Sadeghifar ◽

Marzeyh Sharifi ◽

Zahra Toulideh ◽

...

Keyword(s):

Emergency Department ◽

Waiting Time ◽

Waiting Times ◽

Hospital Data ◽

Governance System ◽

Cross Sectional ◽

Average Waiting Time ◽

Study Population

BACKGROUND & AIMS: Measuring and analyzing of provided services times in Emergency Department is the way to improves quality of hospital services. The present study was conducted with aim measuring and analyzing patients waiting time indicators in Emergency Department in a general hospital in Iran. MATERIAL & METHODS: This cross-sectional, observational study was conducted during April to September 2012. The study population consisted of 72 patients admitted to the Emergency Department at Baharlo hospital. Data collection was carried out by workflow forms. Data were analyzed by t. test and ANOVA. RESULTS: The average waiting time for patients from admission to enter the triage 5 minutes, the average time from triage to physician visit 6 minute and the average time between examinations to leave ED was estimated 180 minutes. The total waiting time in the emergency department was estimated at about 210 minutes. The significant correlation between marital status of patients (P=0.03), way of arrive to ED (P=0.02) and type of shift work (P=0.01) with studied time indicators were observed. CONCLUSION: According to results and comparing with similar studies, the average waiting time of patients admitted to the studied hospital is appropriate. Factors such as: Utilizing clinical governance system and attendance of resident Emergency Medicine Specialist have performed an important role in reducing of waiting times in ED.

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Impact of streaming "fast track" emergency department patients

Australian Health Review ◽

10.1071/ah060525 ◽

2006 ◽

Vol 30 (4) ◽

pp. 525 ◽

Cited By ~ 50

Author(s):

Debra O'Brien ◽

Aled Williams ◽

Kerrianne Blondell ◽

George A Jelinek

Keyword(s):

Emergency Department ◽

Length Of Stay ◽

Waiting Time ◽

Fast Track ◽

Average Length ◽

Waiting Times ◽

Relative Reduction ◽

Average Waiting Time ◽

Discharged Patients ◽

Track Area

Objective: Fast track systems to stream emergency department (ED) patients with low acuity conditions have been introduced widely, resulting in reduced waiting times and lengths of stay for these patients. We aimed to prospectively assess the impact on patient flows of a fast track system implemented in the emergency department of an Australian tertiary adult teaching hospital which deals with relatively few low acuity patients. Methods: During the 12-week trial period, patients in Australasian Triage Scale (ATS) categories 3, 4 and 5 who were likely to be discharged were identified at triage and assessed and treated in a separate fast track area by ED medical and nursing staff rostered to work exclusively in the area. Results: The fast track area managed 21.6% of all patients presenting during its hours of operation. There was a 20.3% (?18 min; 95%CI, ?26 min to ?10 min) relative reduction in the average waiting time and an 18.0% (?41 min; 95%CI, ?52 min to ?30 min) relative reduction in the average length of stay for all discharged patients compared with the same period the previous year. Compared with the 12-week period before the fast track trial, there was a 3.4% (?2.1 min; 95%CI, ?8 min to 4 min) relative reduction in the average waiting time and a 9.7% (?20 min; 95%CI, ?31 min to ?9 min) relative reduction in the average length of stay for all discharged patients. There was no increase in the average waiting time for admitted patients. This was despite major increases in throughput and access block in the study period. Conclusion: Streaming fast track patients in the emergency department of an Australian tertiary adult teaching hospital can reduce waiting times and length of stay for discharged patients without increasing waiting times for admitted patients, even in an ED with few low acuity patients.

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