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 Factors Contributing to Increased Patient Wait Times in Selected Wound Care Patients: A Retrospective Study

2018 ◽  
Vol 3 (2) ◽  
pp. 44
Author(s):  
Joan Aina ◽  
Jochebed Ade-Oshifogun
Keyword(s):  
Quality Improvement ◽  
Retrospective Study ◽  
Care Delivery ◽  
Wound Care ◽  
Patient Flow ◽  
Wait Time ◽  
Health Care Delivery System ◽  
Wait Times ◽  
Institute Of Medicine ◽  
Care Clinic

Background: ‘Waiting’ can be frustrating for anyone especially when it comes to healthcare. The Institute of Medicine advocates changes to improve the quality of the health care delivery system in the United States.Purpose: The purpose of this retrospective study was to determine the factors contributing to increased patient wait times in selected wound care patients. The question guiding this project is-in selected wound care patients who received treatment between September1-December 31, 2013; are factors contributing to prolonged wait times related to treatment-related diagnosis, providers, and clinicians?Method: After institutional review board approval, retrospective charts review was conducted. 300 charts were randomly selected from the electronic health record (EHR) database at a local hospital wound care clinic. 120 charts met the inclusive criteria and were analyzed using ANOVA and SPSS version 22. The Deming cycle for quality improvement was adopted as the framework for practice review and changes.Result: Among all the factors examined, Treatment diagnosis accounted for 4% of the variance (p = 0.416); Providers 1% (p = 0.208); and Clinicians 8% (p = 0.195). Though clinicians had the highest variance, it was not a significant factor for patient wait times. The Deming cycle helps to prioritize and improve communication by creating a chart for effective patient flow through the clinic to reduce wait time.Conclusion: Correcting and improving wait times has the potential for increasing timely access and patient satisfaction. Clinicians and providers are not significant factors contributing to wait times. Wait time should be given priority and be regularly reviewed as part of the quality improvement plan within any organization.

scholarly journals The impact of seasonal operating room closures on wait times for oral cancer surgery

2018 ◽  
Vol 25 (1) ◽  
pp. 67 ◽  
Author(s):  
N. Mundi ◽  
J. Theurer ◽  
A. Warner ◽  
J. Yoo ◽  
K. Fung ◽  
...  
Keyword(s):  
Oral Cavity ◽  
Cancer Patients ◽  
Operating Room ◽  
Oral Cavity Cancer ◽  
Tertiary Care ◽  
Wait Time ◽  
Disease Recurrence ◽  
Health Science ◽  
Wait Times ◽  
The Impact

Background Operating room slowdowns occur at specific intervals in the year as a cost-saving measure. We aim to investigate the impact of these slowdowns on the care of oral cavity cancer patients at a Canadian tertiary care centre.Methods A total of 585 oral cavity cancer patients seen between 1999 and 2015 at the London Health Science Centre (lhsc) Head and Neck Multidisciplinary Clinic were included in this study. Operating room hours and patient load from 2006 to 2014 were calculated. Our primary endpoint was the wait time from consultation to definitive surgery. Exposure variables were defined according to wait time intervals occurring during time periods with reduced operating room hours.Results Overall case volume rose significantly from 2006 to 2014 (p < 0.001), while operating room hours remained stable (p = 0.555). Patient wait times for surgery increased from 16.3 days prior to 2003 to 25.5 days in 2015 (p = 0.008). Significant variability in operating room hours was observed by month, with lowest reported for July and August (p = 0.002). The greater the exposure to these months, the more likely patients were to wait longer than 28 days for surgery (odds ratio per day [or]: 1.07, 95% confidence interval [ci]: 1.05 to 1.10, p < 0.001). Individuals seen in consultation preceding a month with below average operating room hours had a higher risk of disease recurrence and/or death (hazard ratio [hr]: 1.59, 95% ci: 1.10 to 2.30, p = 0.014).Conclusions Scheduled reductions in available operating room hours contribute to prolonged wait times and higher disease recurrence. Further work is needed to identify strategies maximizing efficient use of health care resources without negatively affecting patient outcomes.

scholarly journals The impact on patient flow after the integration of nurse practitioners and physician assistants in 6 Ontario emergency departments

CJEM ◽  
2009 ◽  
Vol 11 (05) ◽  
pp. 455-461 ◽  
Author(s):  
James Ducharme ◽  
Robert J. Alder ◽  
Cindy Pelletier ◽  
Don Murray ◽  
Joshua Tepper
Keyword(s):  
Health Care ◽  
Nurse Practitioners ◽  
Emergency Departments ◽  
Patient Flow ◽  
Physician Assistants ◽  
Wait Times ◽  
Care Providers ◽  
Lengths Of Stay ◽  
Left Without Being Seen ◽  
The Impact

ABSTRACT Objective: We sought to assess the impact of the integration of the new roles of primary health care nurse practitioners (NPs) and physician assistants (PAs) on patient flow, wait times and proportions of patients who left without being seen in 6 Ontario emergency departments (EDs). Methods: We performed a retrospective review of health records data on patient arrival time, time of initial assessment by a physician, time of discharge from the ED and discharge status. Results: Whether a PA or NP was directly involved in the care of patients or indirectly involved by being on duty, the wait times, lengths of stay and proportion of patients who left without being seen were significantly reduced. When a PA or NP were directly involved in patients' care, patients were 1.6 (95% confidence interval [CI] 1.3–2.1, p &lt; 0.05) and 2.1 (95% CI 1.6–2.8, p &lt; 0.05) times more likely to be seen within the wait time benchmarks, respectively. Lengths of stay were 30.3% (95% CI 21.6%–39.0%, p &lt; 0.01) and 48.8% (95% CI 35.0%–62.7%, p &lt; 0.01) lower when PAs and NPs, respectively, were involved. When PAs and NPs were not on duty, the proportion of patients who left without being seen were 44% (95% CI 31%–63%, p &lt; 0.01) and 71% (95% CI 53%–96%, p &lt; 0.05), respectively. Conclusion: The addition of PAs or NPs to the ED team can improve patient flow in medium-sized community hospital EDs. Given the ongoing shortage of physicians, use of alternative health care providers should be considered. These results require validation, as their generalizability to other locations or types of EDs is not known.

scholarly journals A Patient Flow Analysis: Identification of Process Inefficiencies and Workflow Metrics at an Ambulatory Endoscopy Unit

2016 ◽  
Vol 2016 ◽  
pp. 1-7 ◽  
Author(s):  
Rowena Almeida ◽  
William G. Paterson ◽  
Nancy Craig ◽  
Lawrence Hookey
Keyword(s):  
Care Delivery ◽  
Patient Flow ◽  
Qualitative Interviews ◽  
Flow Analysis ◽  
Related Factors ◽  
Endoscopy Unit ◽  
Time And Motion ◽  
Operational Characteristics ◽  
Increasing Demand ◽  
The Impact

Background. The increasing demand for endoscopic procedures coincides with the paradigm shift in health care delivery that emphasizes efficient use of existing resources. However, there is limited literature on the range of endoscopy unit efficiencies.Methods. A time and motion analysis of patient flow through the Hotel-Dieu Hospital (Kingston, Ontario) endoscopy unit was followed by qualitative interviews. Procedures were directly observed in three segments: individual endoscopy room use, preprocedure/recovery room, and overall endoscopy unit utilization.Results. Data were collected for 137 procedures in the endoscopy room, 139 procedures in the preprocedure room, and 143 procedures for overall room utilization. The mean duration spent in the endoscopy room was 31.47 min for an esophagogastroduodenoscopy, 52.93 min for a colonoscopy, 30.47 min for a flexible sigmoidoscopy, and 66.88 min for a double procedure. The procedure itself accounted for 8.11 min, 34.24 min, 9.02 min, and 39.13 min for the above procedures, respectively. The focused interviews identified the scheduling template as a major area of operational inefficiency.Conclusions. Despite reasonable procedure times for all except colonoscopies, the endoscopy room durations exceed the allocated times, reflecting the impact of non-procedure-related factors and the need for a revised scheduling template. Endoscopy units have unique operational characteristics and identification of process inefficiencies can lead to targeted quality improvement initiatives.

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.

Impact of room pooling and electronic health record on patient (pt) wait time, clinic work flow, and pts’/providers’ satisfaction.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e18191-e18191
Author(s):  
Saroj Vadhan-Raj ◽  
Xiao Zhou ◽  
Meyyammai Narayanan ◽  
Shawn J Janarthanan ◽  
Mary Daniel ◽  
...  
Keyword(s):  
Electronic Health Record ◽  
Wait Time ◽  
Work Flow ◽  
Wait Times ◽  
Health Record ◽  
Allocation Model ◽  
Exam Room ◽  
Negative Effect ◽  
Electronic Health ◽  
The Impact

e18191 Background: Excessive pt wait time can have negative effect on clinic work flow and on pts/ providers satisfaction. Increasing pt volume and limited clinic capacity can lead to long wait times for pts. The purpose of this two-part study was to evaluate the impact of Room Pooling Model (RPM) instead of Room Allocation Model (Part 1) and Electronic Health Record (EHR) on pt wait times in clinic and pts’/providers’ satisfaction (Part 2). Methods: The time studies and pts’/providers’ wait time satisfaction surveys were carried out over 2 weeks before (baseline) and 8 weeks after the implementation of RPM (Part 1), prior to the new EHR system, and 6 months after the implementation of EHR (part 2). All times of when pts, mid-level providers (MLP), and doctors (MDs) entered and exited the exam rooms were collected for 887 pts seen during the clinic. Data was analyzed using JMP and SAS. Results: As described earlier (ASCO 2016, abst 6595), the RPM was associated with increase in the proportion of pts seen by MDs within 30 min from the time roomed in the exam room and improvement in pts’/provider’s satisfaction. Post EHR, there were delays with decrease in the proportion of pts seen within 30 min from the time roomed in. Although the pt satisfaction did not change significantly, the number of times MDs had to wait for an open exam room increased from 8% (5/65) to 24% (14/59, p=0.01). The impact of RPM and EHR on pt times are shown below. The delays to see MDs after EHR were associated with longer time spent with the nurse (from median 4 to 7 min) and delays in seeing MLPs (from 11 to 18 min). Conclusions: These findings indicate that RPM can improve pt wait times. During initial stages of EHR implementation, the increase in pt wait time and reduced clinical efficiencies can be related to learning, and adapting to the new system. These data can be useful to design interventions that can target the areas of delays such as training and redesigning workflow to improve the clinical efficiency. [Table: see text]

scholarly journals A comparative study of patient characteristics, opinions, and outcomes, for patients who leave the emergency department before medical assessment

CJEM ◽  
2016 ◽  
Vol 19 (5) ◽  
pp. 347-354 ◽  
Author(s):  
Jacqueline Fraser ◽  
Paul Atkinson ◽  
Audra Gedmintas ◽  
Michael Howlett ◽  
Rose McCloskey ◽  
...  
Keyword(s):  
Health Care ◽  
Emergency Department ◽  
Performance Indicator ◽  
Medical Condition ◽  
Demographic Data ◽  
Family Doctor ◽  
Wait Time ◽  
Wait Times ◽  
Control Group ◽  
Fisher Exact Test

AbstractObjectiveThe emergency department (ED) left-without-being-seen (LWBS) rate is a performance indicator, although there is limited knowledge about why people leave, or whether they seek alternate care. We studied characteristics of ED LWBS patients to determine factors associated with LWBS.MethodsWe collected demographic data on LWBS patients at two urban hospitals. Sequential LWBS patients were contacted and surveyed using a standardized telephone survey. A matched group of patients who did not leave were also surveyed. Data were analysed using the Fisher exact test, chi-square test, and student t-test.ResultsThe LWBS group (n=1508) and control group (n=1504) were matched for sex, triage category, recorded wait times, employment and education, and having a family physician. LWBS patients were younger, more likely to present in the evening or at night, and lived closer to the hospital. A long wait time was the most cited reason for leaving (79%); concern about medical condition was the most common reason for staying (96%). Top responses for improved likelihood of waiting were shorter wait times (LWBS, 66%; control, 31%) and more information on wait times (41%; 23%). A majority in both groups felt that their condition was a true emergency (63%; 72%). LWBS patients were more likely to seek further health care (63% v. 28%; p<0.001) and sooner (median time 1 day v. 2-4 days; p=0.002). Among patients who felt that their condition was not a true emergency, the top reason for ED attendance was the inability to see their family doctor (62% in both groups).ConclusionLWBS patients had similar opinions, experiences, and expectations as control patients. The main reason for LWBS was waiting longer than expected. LWBS patients were more likely to seek further health care, and did so sooner. Patients wait because of concern about their health problem. Shorter wait times and improved communication may reduce the LWBS rate.

scholarly journals Innovative Strategies for Decreasing Blood Collection Wait Times for Patients in Early-Phase Cancer Clinical Trials

2016 ◽  
Vol 12 (7) ◽  
pp. e784-e791 ◽  
Author(s):  
Bayabel Mengistu ◽  
Dina Ray ◽  
Passion Lockett ◽  
Vivian Dorsey ◽  
Ron A. Phipps ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Early Phase ◽  
Patient Flow ◽  
Care Facility ◽  
Cost Savings ◽  
Primary Source ◽  
Wait Time ◽  
Turnover Time ◽  
Wait Times ◽  
Blood Collection

Purpose: Long wait times are a primary source of dissatisfaction among patients enrolled in early-phase clinical trials. We hypothesized that an automated patient check-in system with readily available display for increasing awareness of waiting intervals would improve patient flow and use of our rooms, with decreased turnover time and increased throughput. Methods: We recorded in-room wait times for patients seen in our clinic and observed the logistics involved in the blood collection process to delineate causes for delays. We then implemented a three-step strategy to alleviate the causes of these delays: (1) changing the collection of materials and the review of faxed orders, (2) improving our LabTracker automated database system that included wait time calculators and real-time information regarding patient status, and (3) streamlining lower complexity appointments. Results: After our intervention, we observed a 19% decrease in mean wait times and a 30% decrease in wait times among patients waiting the longest (95th percentile). We also observed an increase in staff productivity during this process. Modifications in LabTracker provided the biggest reduction in mean wait times (17%). Conclusion: We observed a significant decrease in mean wait times after implementing our intervention. This decrease led to increased staff productivity and cost savings. Once wait times became a measurable metric, we were able to identify causes for delays and improve our operations, which can be performed in any patient care facility.

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.

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