PATIENT FLOW: FOLLOW – UP REPORT
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PATIENT FLOW: FOLLOW – UP REPORT
Agoncillo, Asperas, Cosalan, Tanbonliong
ASMIP 2009
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BACKGROUND
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OBJECTIVESGeneral Objective
This follow-up study seeks to evaluate the current operation system of American Eye Center in terms of waiting lines and patient flow.
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Specific Objectives
• Determine statistical trends on patient volume according to: – Time interval in a day– Day of the week– Age group– Chart type
• Compare the current and previous trends on patient volume
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• Evaluate the general flow of patients in the clinic on light and heavy days within the period after the initial study on operations management
• Assess the utilization of examination rooms and relate it to patient volume and turnover from optometrist to ophthalmologist
• Identify changes in the operation system and relate these to the current patient flow and waiting time
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• Assess the recommendations from the previous study
• Provide recommendations that will improve the waiting lines and patient flow
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SIGNIFICANCE OF THE STUDY
• Assess and evaluate the current patient flow system being employed
• Identify weak and strong points of the system to improve
• Provide tools and recommendations to keep the operations of the center as efficient as possible
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SCOPE AND LIMITATIONS
• Study is based on changes made by a previous study conducted last year
• Statistical data from June 2008 to May 2009
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DATA COLLECTION
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PATIENT VOLUME• All statistical data from
June 2008 to May 2009 were taken from log books provided by the reception
• Categories– Time intervals– Age– Chart type
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PATIENT DATA PROCESSING AT FRONT DESK PER PATIENT CATEGORY
Reception Area
Walk-ins
Old Patient: Files are retrieved from the encoding system is retrieved from the 2nd
floor office
New Patient:Fill out an
information sheet
With Appointment
Files are retrieved from the 2nd floor office
beforehand
Measured the time from when the patient first approaches thereception area until it is stacked in the chart box
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TURNOVER FROM CHART BOX TO OPTOMETRIST
• Optometrist takes a file and starts to perform the routine or special procedures
• Measured the time interval when a patient’s file is stacked into the chart box until an optometrist can accommodate the patient
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GENERAL SCREENING• Routine tests: Automated Refractometry,
Air Puff Tonometry, Corneal Topography and Specular Microscopy
• Start is when the optometrists calibrates the machine and end when the results are released
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ROOM USE
• All 5 rooms are timed according to usage
• Availability of the rooms is an important factor to the patient’s waiting time
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OPTOMETRIST ROOM USE
• Test the grade of the patient’s eyes using the Snellen and jaegger chart
• Specific tests done to patients include color blindness tests, pupillometry and contrast sensitivity test
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TURNOVER FROM OPTOMETRIST TO OPHTHALMOLOGIST
• Measured by timing the end of the patient’s session with the optometrist until the ophthalmologist is ready to see them
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OPHTHALMOLOGIST ROOM USE
• There are no private use for physicians, thus they are able to use any available room
• The time for room usage is measured from when the doctor meets the patient until their consultation is over
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INTERVIEW • Receptionist – Patient categories, scheduling of patients and
general information• Records Assistant– Filing system the clinic utilizes
• Optometrists– Routine patient flow and equipment being used
• Ophthalmologist– Services they offer, routine and special procedures
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DATA ANALYSIS• Frequency distribution – Patient category, age group, visit to the clinic according to
the time and date • Figures– Patient Volume by Time Interval per Weekday– Patient Volume by Time Interval per Month– Patient Volume by Weekday per Month– Patient Volume by Age Group per Month– Patient Volume by Age Group per Day in a Week– Patient Volume by Chart Type per Month – Patient Volume by Chart Type per Weekday
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AVERAGE PATIENT VOLUME BY TIME INTERVAL PER WEEKDAY
TIME INTERVAL ASMIP 2008 ASMIP 2009
7:00 – 7:59 0 1
8:00 – 8:59 10 9
9:00 – 9:59 18 18
10:00 – 10:59 18 19
11:00 – 11:59 17 18
12:00 – 12:59 15 14
1:00 – 1:59 15 16
2:00 – 2:59 14 14
3:00 – 3:59 10 10
4:00 – 4:59 8 9
5:00 – 5:59 3 3
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AVERAGE PATIENT VOLUME BY TIME INTERVAL PER MONTH
TIME AVERAGE
7:00 – 7:59 27
8:00 – 8:59 212
9:00 – 9:59 443
10:00 – 10:59 458
11:00 – 11:59 435
12:00 – 12:59 342
1:00 – 1:59 392
2:00 – 2:59 325
3:00 – 3:59 240
4:00 – 4:59 175
5:00 – 5:59 61
6:00 – 6:59 1
MONTH AVERAGEJune 250
July 284
August 259
September 265
October 261
November 250
December 194
January 302
February 259
March 296
April 232
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PATIENT VOLUME BY
WEEKDAY PER MONTH
WEEKDAY ASMIP 2008 ASMIP 2009
Monday 117 114
Tuesday 135 137
Wednesday 109 112
Thursday 105 116
Friday 134 139
Saturday 148 156
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PATIENT VOLUME BY AGE GROUP PER
MONTH
AGE GROUP TOTAL0 – 18 2738
19 – 59 20689
60 AND ABOVE 10493
MISSING DATA 301
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PATIENT VOLUME BY AGE GROUP PER DAY
IN A WEEK
WEEKDAY ASMIP 2008
ASMIP 2009
Monday 117 115
Tuesday 146 136
Wednesday 109 112
Thursday 105 115
Friday 134 138
Saturday 148 154
AGE GROUP
ASMIP 2008 ASMIP 2009
0 – 18 10 10
19 – 59 82 78
60 ABOVE 35 40
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PATIENT VOLUME BY CHART TYPE PER MONTH
CHART TYPE
ASMIP 2008
ASMIP 2009
GC 661 794
FF 1689 1956
LS 162 132
SX 221 231
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PATIENT VOLUME BY CHART TYPE PER WEEKDAY
WEEKDAY ASMIP 2008 ASMIP 2009
Monday 117 114
Tuesday 146 138
Wednesday 109 112
Thursday 105 116
Friday 134 139
Saturday 148 156
CHART TYPE
ASMIP 2008
ASMIP 2009
GC 31 33
FF 76 81
LS 8 6
SX 12 10
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GENERAL FLOW OF PATIENTS
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PATIENT DATA PROCESSING AT FRONT DESK
Registration
Patient given SmartQ number
Reception desk processed their patient chart
Chart is retrieved, updated and placed in
chart box for optometrist
Patients are grouped into 3 categories: new,
follow-up, with appointment
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Previous
Current
New Patient Follow-up Appointment Total
Sample Size 3010 10 10 30
Mean 3:02 0:12 0:29 0:09 0:16
Median 2:37 0:13 0:30 0:07 0:15
Std. Deviation 1:320:05 0:12 0:09 0:08
Minimum 1:01 0:03 0:07 0:01 0:01
Maximum 7:280:19 0:45 0:29 0:45
DATA PROCESSING AT FRONT DESK
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TURNOVER FROM CHART BOX TO OPTOMETRISTS
T ime from c hart box to optometris t
0:00:00
0:14:24
0:28:48
0:43:12
0:57:36
1:12:00
1:26:24
10:
23:0
0 AM
10:
37:0
2 AM
10:
44:1
8 AM
10:
54:5
1 AM
11:
13:1
5 AM
11:
27:0
8 AM
11:
34:0
0 AM
11:
43:3
3 AM
11:
52:0
4 AM
11:
59:5
4 AM
12:
06:3
4 PM
12:
18:4
4 PM
12:
22:0
5 PM
12:
31:0
3 PM
12:
37:2
3 PM
1:4
2:00
PM
2:0
1:00
PM
2:5
4:00
PM
3:0
2:00
PM
3:1
2:00
PM
3:5
0:00
PM
4:0
6:00
PM
4:2
6:00
PM
4:5
5:00
PM
5:2
3:00
PM
T ime
Tota
l tim
e
S eries 1
P oly.(S eries 1)
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GS: Automated Refractometry
PreviousCurrent
Sample Size 33 50
Mean 1:05 0:59
Median 1:08 0:50Std. Deviation 0:22
0:28
Minimum 0:30 0:25
Maximum 2:05 2:28
Increase in standard deviation and range of values
Mean and median decreased
Increase in dispersion can be attributed to the increase in sample size
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GS: AIR PUFF TONOMETRYPrevious
Current
Sample Size 3450
Mean 0:41 0:35
Median 0:33 0:35
Std. Deviation 0:20
0:10
Minimum 0:20 0:19
Maximum 1:53 1:06
Takes the shortest time to complete
Decrease in mean duration and standarddeviation in this phase
Maximum time observed in the later study decreased by a minute as compared to the initial study
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GS: CORNEAL TOPOGRAPHY
PreviousCurrent
Sample Size 32 50
Mean 1:49 2:05
Median 1:36 1:56
Std. Deviation 0:46
1:02
Minimum 0:59 0:31
Maximum 4:095:31
Time increased to 2 min and 5 seconds
Median also increased to 2 min
Increase in standard deviation suggestinga more dispersed data which represents the time it takes for different optometrists to use the machine
Considering the bulk of patients using themachine, there is a significant increase in turnover time
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GS: SPECULAR MICROSCOPY
Previous Current
Sample Size 32 50Mean 1:42 1:38Median 1:44 1:33Std. Deviation 0:44
0:30
Minimum 0:30 0:50Maximum 3:06 2:46
There is a significant difference in theminimum and maximum times it takes to use the machine from the previous study
Decrease in standard deviation
Notable improvement in terms of time management and utility of the machine
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OPTOMETRIST ROOM USE
PreviousCurrent
Sample Size 50 50
Mean 06:03 06:12
Median 06:00 06:07Std.
Deviation 02:3802:32
Minimum 01:00 01:00
Maximum 13:0015:00
A high standard deviation from both studies
Optometrist may take as long as 15min and as short as 1 min
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TURNOVER FROM OPTOMETRIST TO OPHTHALMOLOGIST
Previous Current
Sample Size 31 50
Mean 00:33:10 00:24:57
Median 00:20:00 00:21:24
Std. Deviation 00:32:55 00:10:36
Minimum 00:01:40 00:02:05
Maximum 02:29:00 00:42:11
The patient waiting for a room to be available
Large improvement this year as compared to last year
Decrease in the mean time and standard deviation
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OPTHALMOLOGIST ROOM USE
Previous CurrentSample Size 50 50Mean 06:47 06:52Median 06:50 06:43Std. Deviation 04:03 03:22Minimum 01:00 01:00Maximum 17:00 14:54
Ophthalmologists usually perform less tests than optometrists
The maximum time may be attributed to consultations that patients and their familymay have with the doctors thus resultingto a maximum time similar to that of the optometrists
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ROOM UTILITY
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CATARACT SURGERY DAY: MAY 26
Room 1 0:07
Room 2 0:07
Room 3 0:08
Room 4 0:09
Room 5 0:11
Average 0:08
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• DURATION OF USE BY TIME INTERVAL PER EXAM ROOM: May 26
8:00 – 8:59
9:00 – 9:59
10:00 – 10:59
11:00 – 11:59
12:00 - 12:59
1:00 - 1:59
2:00 - 2:59
3:00 - 3:59
4:00 - 4:59
5:00 - 5:59
Room 1 0:00 0:06 0:08 0:05 0:06 0:05 0:08 0:10 0:26 0:10Room 2 0:09 0:20 0:06 0:04 0:08 0:07 0:10 0:05 0:06 0:11Room 3 0:09 0:08 0:09 0:07 0:06 0:13 0:07 0:08 0:08 0:06Room 4 0:00 0:09 0:14 0:14 0:04 0:09 0:05 0:21 0:05 0:10Room 5 0:06 0:23 0:07 0:06 0:21 0:15 0:06 0:11 0:13 0:43
AVE 0:04 0:13 0:08 0:07 0:09 0:09 0:07 0:11 0:11 0:16
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LASIK SURGERY DAY: May 29
Room 1 0:05
Room 2 0:12
Room 3 0:09
Room 4 0:11
Room 5 0:11
Average 0:09
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• DURATION OF USE BY TIME INTERVAL PER EXAM ROOM: May 26
8:00 - 8:59
9:00 - 9:59
10:00 - 10:59
11:00 - 11:59
12:00 - 12:59
1:00 - 1:59
2:00 - 2:59
3:00 - 3:59
4:00 - 4:59
5:00 - 5:59
Room 1 0:25 0:10 0:04 0:08 0:06 0:02 0:03 0:06 0:06 0:02
Room 2 0:05 0:45 0:24 0:10 0:13 0:08 0:10 0:09 0:10 0:08
Room 3 0:09 0:15 0:08 0:07 0:07 0:14 0:09 0:11 0:14 0:08
Room 4 0:11 0:19 0:12 0:12 0:13 0:09 0:06 0:10 0:20 0:06
Room 5 0:10 0:17 0:09 0:12 0:18 0:23 0:08 0:11 0:13 0:05
AVE 0:12 0:21 0:11 0:09 0:11 0:11 0:07 0:09 0:12 0:05
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ROOM UTILITY ON A SATURDAY: May 30
Room 1 0:05Room 2 0:08Room 3 0:12Room 4 0:09Room 5 0:10Average 0:08
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• DURATION OF USE BY TIME INTERVAL PER EXAM ROOM: May 30
8:00 - 8:59 9:00 - 9:59 10:00 - 10:59 11:00 - 11:59 12:00 - 12:59 1:00 - 1:59Room 1 0:24 0:03 0:03 0:04 0:08 0:05
Room 2 0:10 0:12 0:08 0:08 0:06 0:07
Room 3 0:23 0:11 0:16 0:12 0:10 0:08
Room 4 0:07 0:14 0:06 0:09 0:11 0:00
Room 5 0:08 0:12 0:11 0:16 0:06 0:11
AVERAGE 0:14 0:10 0:08 0:09 0:08 0:06
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CONCLUSION• Statistical trends on patient volume– Peaks before and after lunch– Saturday contains the highest volume of patients– Majority of patients are of working age (19 – 59) – Majority of patients are in the clinic for follow-up
(FF)
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• Comparison of current and previous study– Increase in total number of patients– Increase in GC: 661 – 794– Increase in FF: 1956 – 1689– Increase in LS: 132 – 162– Increase in SX: 221 – 231– Change in trend according to time interval• Previous study
– Linear decline in patient volume• Current study
– Two peaks in patient volume (before and after lunch)
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– Same trend according to workday • Tuesday, Friday and Saturday = most number of
patients– Same distribution according to age group• Majority of patients from 19 – 59 age group• Increase in percentage of patients from the 60 and
above group
• Evaluate the general flow of patients in the clinic on light and heavy days within the period after the initial study on operations management
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– Decrease in the processing time• From 3:02 to 0:16
– Increase in turnover duration from chart to opto at 11:30am • Charts started to pile up due to increase in patient
volume• Peak at 1:00pm due to a decrease in the number of
optometrists– No significant change in general screening, opto
and ophtha room use– Decrease in turnover from opto to ophtha
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• Assess the utilization of examination rooms and relate it to patient volume and turnover time from optometrist to ophthalmologist– Same trend– Increase in utilization• More efficient, less periods of vacancy
– Decrease turnover time from opto to optha– Increase in number of patients served per hour
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• Identify changes in the operation system and relate these to the current patient flow and waiting time– Charts from the box have numbers that are being
followed– More efficient use of exam rooms– Generally, no change in the system; changes in the
efficiency of people in the system (encoding, chart prioritization, room assignment and use)
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ON LAST YEAR’S RECOMMENDATIONS... • Repartitioning of rooms• Expansion or satellite clinics• ID system• Centralized computer database• Cut-off time for walk in patients• Penalty system for late follow-up patients• Surgery appointment penalties• More doctors present on Tuesday mornings• Scheduling surgeries in the morning• Extended Saturday work hours• Rescheduling patients based on maximum turnover capacity• Monitoring personnel at the chart box or box management
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RECOMMENDATIONS• Adhere to an appointment based institution • Scheduled breaks of optometrists• Maintain a cut-off time – Lessen incoming late patients and limit the quota
• Hiring more personnel or training more employees to help with record keeping and retrieval of files
• Investment in machines • Automation of files