Evaluation and Improvement of Bottlenecking in a Multidisciplinary Oncology Clinic: An Electronic Medical Record Intervention
| Autor: | Mary K. Dean, Victor J Hassid, Matthew S. Ning, Elizabeth S. Bloom, Isidora Arzu, Shalin J. Shah, Mark A. Lewis, Neelesh Mutyala, Caitlin M. Byler, Timisha Joe, Kyle A Taylor, Prakul Suresh, Nicole D. Fleming, Janet Tu |
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| Rok vydání: | 2019 |
| Předmět: |
workflow design
medicine.medical_specialty Quality management business.industry General Engineering Psychological intervention Electronic medical record Healthcare Technology 030204 cardiovascular system & hematology Quality Improvement Test (assessment) 03 medical and health sciences 0302 clinical medicine Oncology Multidisciplinary approach process optimization Intervention (counseling) outpatient Physical therapy medicine business PDCA 030217 neurology & neurosurgery Morning |
| Zdroj: | Cureus |
| ISSN: | 2168-8184 |
| Popis: | Purpose: Clinic members reported slower patient flow in the mornings at a multidisciplinary oncology clinic. This study identified the causes of clinic bottlenecking via analysis of patient schedules and transit times, then corrected discrepancies through a quality improvement program. Methods: Transit times were measured using tracking cards handed out at check-in, marked by each clinic member throughout the encounter, and collected upon discharge. Data were analyzed for differences between morning and afternoon patients, and a Pareto chart was formulated to assess for discrepancies in distribution. Repeat plan-do-study-act (PDSA) cycles were conducted, implementing two changes to redistribute appointments to optimize clinic workflow. Results: A total of 2951 patient appointments were analyzed: 589 at baseline, 277 following an initial intervention, and 2085 following a subsequent intervention. Analysis of patient transit times revealed no significant differences between morning and afternoon patient groups (t-test, p=.13-.99), with no transit interval markedly longer than others (t-test, p=.32-.83). However, upon evaluation of appointment times, a maldistribution was noted with 57% of patients concentrated between 9:00 am to 12:00 pm, accounting for the perception of bottlenecking. An initial intervention offering patients afternoon appointments on a voluntary basis was insufficient for rebalancing distribution (chi-square test, p=.299); however, an electronic medical record (EMR) intervention with rigid appointment templates was successful (chi-square test, p |
| Databáze: | OpenAIRE |
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