Workflow Improvement

8/11/2019 Workflow Improvement

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Emory

DermatologyClinicS A R A A B B Y C H A P M A N

J U S T I N H U F F

F E L I X L A G A R D E

S R I N I V A S P O L U R U


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About Emory~27000 patient annually13 doctors


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The Problem


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Project GoalsIdentify bottlenecks and opportunities to improve workflowReduce patient time alone in room

Minimize overtime of EDC staff

Increase stakeholder satisfaction


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The Typical Patient


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Ratio of Face Time toScheduled Appointment

Duration


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No-show Rates by

Weekday

15.76%

19.61%

15.84%

12.51% 13.30%

Mon Tue Wed Thur Fri

Mean no-show rate: 15.73%

Median no-show rate: 11.11%


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Patient Time in Exam

Room


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Simulation ModelGeneral

Dermatology

Clinic

INPUTS

Patient schedule

Resource availability

Flow logic

Service times

OUTPUTS

Patient wait time

Time alone in room

Patient time in room

Total clinic duration


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Simulation Model ValidationCorrelation inspection approach

Observed system

input data

Observed system

input data

System output

data

Actual SystemSimulation

Model

Model output

dataCompare


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Scenarios 1 & 2


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Scenarios 3 & 4


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Scenarios 5 & 6


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RecommendationsInstitute policy in which learners are allowed to examinepatients only if clinic is running up to 10 min late

Schedule appointments 10 min earlier to reduce effect of

late arrivals on the system

Increase overbooking by an average of 1.5 patients


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Impact of

RecommendationsNo significant changes on: Time to room

Total time in room

Total clinic duration

Significant increase in wait time to room of 8.0 min onaverage

Clinic is able to attend 1.28 more patients on average


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Summary of FindingsResident impacts clinic durationPatient spends a significant amount of time alone in theroom

Doctor face time is the key driver

System can cope with one additional patient at nosignificant change in the clinic duration


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Future ResearchConverting patient wait time to value-added timeAnalyzing how doctor time in exam room can be optimized

Investigating impact of resident presence on chartingquality and duration


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Literature Review


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Appendixes


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Simulation ModelChange room and nurse allocationAvailability of resident/medical student

Change arrival and no-show pattern of patients

Change process duration for individual patients


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Simulation Model Validation

0

20

40

60

80

Observed Simulation

Time(min)

Wait Time to Room

95% CI Mean Mean

0

10

20

30

4050

60

Observed Simulation

Time(min)

Time Alone in Room

95% CI Mean Mean

0

50

100

150

200

Observed Simulation

Time(min)

Total Time in Room

95% CI Mean Mean

0

100

200

300

400

Observed Simulation

Time(min)

Total Clinic Time

95% CI Mean Mean


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Simulated Scenarios1. Clinics assigned 1.5 nurses2. Learners examine patient if appointment is within a clinic lateness

threshold

3. Reduced variability in doctor face-time

4. Reduced mean doctor face-time

5. Patients scheduled prior to appointment time

6. Effect of decreased no-show rates in clinic duration


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Impact of Final

RecommendationsPatient Time in Room

Time(min)

Scenarios


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Impact Final

RecommendationsTime to Room

Time(min)

Scenarios


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Impact Final

RecommendationsTotal Clinic Duration

Time(min)

Scenarios


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Impact Final

RecommendationsTime Alone in Room

Time(min)

Scenarios


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Impact Final

RecommendationsPatient Serviced

Time(min)

Scenarios


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Effect of Learner Policies


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Reduce Variability Doctor

Face Time


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Face Time


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Face Time


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Reduce Mean Doctor Face

Time


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Time


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Time


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Time


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Offset Appointment

Schedule


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Offset Appointment

Schedule


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Offset AppointmentSchedule


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Effect of Reducing No-Shows


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Workflow Improvement

Documents

Transcript of Workflow Improvement