Improving Visit Cycle Time Using Patient Flow Analysis in a High–Volume Inner–City Hospital–Based Ambulatory Clinic Serving Minority New Yorkers

Dhar, Sanjay; Michel, Raquel; Kanna, Balavenkatesh

doi:10.1111/j.1945-1474.2010.00111.x

Cited by 11 publications

(9 citation statements)

References 9 publications

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“…A hospital ambulatory clinic analysis of patient flow led to health service delivery improvement by implementing fewer patient stops, better communication among staff, regular brief meetings, and pre-assessment of patient schedules. 9 In the present study, good practices and areas for improvement were identified and could serve as the basis for recommendations for better delivery of services in UPHS.…”

Section: Discussionmentioning

confidence: 97%

Patient Flow, Health Delivery Processes, and Areas for Improvement in the UP Health Service (UPHS) during May to June 2020 of the COVID-19 Pandemic

et al. 2021

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Background. Workplace or employees’ clinics play a vital role in disease outbreaks as there could be an influx of sick personnel. Processes and patient flows during pandemics should be documented to identify good practices and sources of operational inefficiencies. Objective. To describe the patient flow, health delivery processes, and areas for improvement at the UPHS during the early phase of the COVID-19 pandemic from May to June 2020. Methods. This was a cross-sectional study involving patient flow analysis of processes at the employees’ clinic of the University of the Philippines-Philippine General Hospital. The study was divided into two major components: clinic process time measurement and process flow mapping. Data collection involved time elements and narrative descriptions of good practices and problems in the process flow. Results. The UPHS staff attended to 1,514 employees’ visits during the 15 working days from May to June 2020. The total UPHS service time from arrival to end of consultation of an employee with a COVID-19-related concern was an average of 1 hour 3 minutes (SD±39 minutes) with a mean total waiting time of 46 minutes (SD±37 minutes). Good practices identified were personnel flexibility in doing other tasks, good communication, and infection control measures. Areas for improvement included symptom screening, implementation of physical distancing, and disinfection practices. Conclusion. The process flows in the UPHS clinic consisted of COVID-19 related consultations, non-COVID-19 related concerns, and swabbing services. Good communication, staff flexibility, infection control measures, and leadership were identified as good practices. Occasional lapses in symptom screening at triage, physical distancing among employees in queuing lines, and inconsistent disinfection practices were the areas for improvement.

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Section: Discussionmentioning

confidence: 97%

Patient Flow, Health Delivery Processes, and Areas for Improvement in the UP Health Service (UPHS) during May to June 2020 of the COVID-19 Pandemic

et al. 2021

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“…The first step was to use PFA to assess the existing workflow and establish a baseline for comparison. PFA is a broadly replicable practice by which the entire care process is outlined, from the patient perspective, to identify inefficiencies or bottlenecks and develop potential solutions [9][10][11]. The PFA involves quantifying the amount of time spent at each step, identifying which staff members are involved, and describing the specific tasks performed during each component of the visit.…”

Section: Patient Flow Analysismentioning

confidence: 99%

Using patient flow analysis with real-time patient tracking to optimize radiation oncology consultation visits

Mesko

Weng

Das

et al. 2022

BMC Health Serv Res

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Purpose Clinical efficiency is a key component of the value-based care model and a driver of patient satisfaction. The purpose of this study was to identify and address inefficiencies at a high-volume radiation oncology clinic. Methods and materials Patient flow analysis (PFA) was used to create process maps and optimize the workflow of consultation visits in a gastrointestinal radiation oncology clinic at a large academic cancer center. Metrics such as cycle times, waiting times, and rooming times were assessed by using a real-time patient status function in the electronic medical record for 556 consults and compared between before vs after implementation of the PFA recommendations. Results The initial PFA revealed four inefficiencies: (1) protracted rooming time, (2) inefficient communications, (3) duplicated tasks, and (4) ambiguous clinical roles. We analyzed 485 consult-visits before the PFA and 71 after the PFA. The PFA recommendations led to reductions in overall median cycle time by 21% (91 min vs 72 min, p < 0.001), in cumulative waiting times by 64% (45 min vs 16 min; p < 0.001), which included waiting room time (14 min vs 5 min; p < 0.001) and wait for physician (20 min vs. 6 min; p < 0.001). Slightly less than one-quarter (22%) of consult visits before the PFA lasted > 2 h vs. 0% after implementation of the recommendations (p < 0.001). Similarly, the proportion of visits requiring < 1 h was 16% before PFA vs 34% afterward (p < 0.001). Conclusions PFA can be used to identify clinical inefficiencies and optimize workflows in radiation oncology consultation clinics, and implementing their findings can significantly improve cycle times and waiting times. Potential downstream effects of these interventions include improved patient experience, decreased staff burnout, financial savings, and opportunities for expanding clinical capacity.

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“…PFA is a broadly replicable practice by which the entire care process is outlined, from the patient perspective, to identify ine ciencies or bottlenecks and develop potential solutions. [9][10][11] The PFA involves quantifying the amount of time at each step, identifying which staff are involved, and describing the speci c tasks performed at each component of the visit. This data-gathering phase took place from February 2019 through May 2019 and consisted of in-person observations as well as extraction of data from the electronic medical record (EMR).…”

Section: Patient Flow Analysismentioning

confidence: 99%

Using Patient Flow Analysis with Real-Time Patient Tracking to Optimize Radiation Oncology Consultation Visits

Mesko

Weng

Das

et al. 2022

Preprint

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Purpose: Clinical efficiency is a key component of the value-based care model and a driver of patient satisfaction. The purpose of this study was to identify and address inefficiencies at a high-volume radiation oncology clinic.Methods and Materials: Patient flow analysis (PFA) was used to create process maps and optimize the workflow of consultation visits in a gastrointestinal radiation oncology clinic at a large academic cancer center. Metrics such as cycle times, waiting times, and rooming times were compared before vs after implementation of the PFA recommendations by using a real-time patient status function in the electronic medical record for 556 consults. Results: The initial PFA revealed four inefficiencies: (1) protracted rooming time, (2) inefficient communications, (3) duplicated tasks, and (4) ambiguous clinical roles. We analyzed 485 consult-visits before the PFA and 71 after the PFA. The PFA recommendations led to reductions in overall median cycle time by 21% (91 min vs 72 min, p<0.001), in cumulative waiting times by 64% (45 min vs 16 min; p<0.001), which included waiting room time (14 min vs 5 min; p<0.001); and wait for physician (20 min vs. 6 min; p<0.001). Slightly less than one-quarter (22%) of consult visits before the PFA lasted >2 hours vs. 0% after implementation of the recommendations (p<0.001). Similarly, the proportion of visits requiring <1 hour was 16% before PFA vs 34% afterward (p<0.001). Conclusions: PFA can be used to identify clinical inefficiencies and optimize workflows in radiation oncology consultation clinics, and implementing their findings can significantly improve cycle times and waiting times. Potential downstream effects of these interventions include improved patient experience, decreased staff burnout, financial savings, and opportunities for expanding clinical capacity.

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Improving Visit Cycle Time Using Patient Flow Analysis in a High–Volume Inner–City Hospital–Based Ambulatory Clinic Serving Minority New Yorkers

Cited by 11 publications

References 9 publications

Patient Flow, Health Delivery Processes, and Areas for Improvement in the UP Health Service (UPHS) during May to June 2020 of the COVID-19 Pandemic

Patient Flow, Health Delivery Processes, and Areas for Improvement in the UP Health Service (UPHS) during May to June 2020 of the COVID-19 Pandemic

Using patient flow analysis with real-time patient tracking to optimize radiation oncology consultation visits

Using Patient Flow Analysis with Real-Time Patient Tracking to Optimize Radiation Oncology Consultation Visits

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