Using Operational Analysis to Improve Access to Pulmonary Function Testing

Abstract

Background. Timely pulmonary function testing is crucial to improving diagnosis and treatment of pulmonary diseases. Perceptions of poor access at an academic pulmonary function laboratory prompted analysis of system demand and capacity to identify factors contributing to poor access. Methods. Surveys and interviews identified stakeholder perspectives on operational processes and access challenges. Retrospective data on testing demand and resource capacity was analyzed to understand utilization of testing resources. Results. Qualitative analysis demonstrated that stakeholder groups had discrepant views on access and capacity in the laboratory. Mean daily resource utilization was 0.64 (SD 0.15), with monthly average utilization consistently less than 0.75. Reserved testing slots for subspecialty clinics were poorly utilized, leaving many testing slots unfilled. When subspecialty demand exceeded number of reserved slots, there was sufficient capacity in the pulmonary function schedule to accommodate added demand. Findings were shared with stakeholders and influenced scheduling process improvements. Conclusion. This study highlights the importance of operational data to identify causes of poor access, guide system decision-making, and determine effects of improvement initiatives in a variety of healthcare settings. Importantly, simple operational analysis can help to improve efficiency of health systems with little or no added financial investment.

Optimal NIV Medicare Access Promotion: Patients With Hypoventilation Syndromes

“…Spirometry may not always be readily available or possible, and therefore delays in treatment can result. 33 In addition, although some pulmonary measurements such as functional residual capacity and expiratory reserve volume decrease with increasing BMI, spirometric variables are rarely below the normal range. Hypoventilation often co-exists with hypoxemia, but the administration of supplemental oxygen alone in hypoventilation syndromes has the potential to worsen hypercapnia by various mechanisms.…”