8/11/2019 Workflow Improvement
1/44
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
8/11/2019 Workflow Improvement
2/44
About Emory~27000 patient annually13 doctors
8/11/2019 Workflow Improvement
3/44
The Problem
8/11/2019 Workflow Improvement
4/44
Project GoalsIdentify bottlenecks and opportunities to improve workflowReduce patient time alone in room
Minimize overtime of EDC staff
Increase stakeholder satisfaction
8/11/2019 Workflow Improvement
5/44
The Typical Patient
8/11/2019 Workflow Improvement
6/44
Ratio of Face Time toScheduled Appointment
Duration
8/11/2019 Workflow Improvement
7/44
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%
8/11/2019 Workflow Improvement
8/44
Patient Time in Exam
Room
8/11/2019 Workflow Improvement
9/44
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
8/11/2019 Workflow Improvement
10/44
Simulation Model ValidationCorrelation inspection approach
Observed system
input data
Observed system
input data
System output
data
Actual SystemSimulation
Model
Model output
dataCompare
8/11/2019 Workflow Improvement
11/44
Scenarios 1 & 2
8/11/2019 Workflow Improvement
12/44
Scenarios 3 & 4
8/11/2019 Workflow Improvement
13/44
Scenarios 5 & 6
8/11/2019 Workflow Improvement
14/44
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
8/11/2019 Workflow Improvement
15/44
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
8/11/2019 Workflow Improvement
16/44
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
8/11/2019 Workflow Improvement
17/44
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
8/11/2019 Workflow Improvement
18/44
Literature Review
8/11/2019 Workflow Improvement
19/44
Appendixes
8/11/2019 Workflow Improvement
20/44
Simulation ModelChange room and nurse allocationAvailability of resident/medical student
Change arrival and no-show pattern of patients
Change process duration for individual patients
8/11/2019 Workflow Improvement
21/44
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
8/11/2019 Workflow Improvement
22/44
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
8/11/2019 Workflow Improvement
23/44
Impact of Final
RecommendationsPatient Time in Room
Time(min)
Scenarios
8/11/2019 Workflow Improvement
24/44
Impact Final
RecommendationsTime to Room
Time(min)
Scenarios
8/11/2019 Workflow Improvement
25/44
Impact Final
RecommendationsTotal Clinic Duration
Time(min)
Scenarios
8/11/2019 Workflow Improvement
26/44
Impact Final
RecommendationsTime Alone in Room
Time(min)
Scenarios
8/11/2019 Workflow Improvement
27/44
Impact Final
RecommendationsPatient Serviced
Time(min)
Scenarios
8/11/2019 Workflow Improvement
28/44
Effect of Learner Policies
8/11/2019 Workflow Improvement
29/44
Effect of Learner Policies
8/11/2019 Workflow Improvement
30/44
Effect of Learner Policies
8/11/2019 Workflow Improvement
31/44
Effect of Learner Policies
8/11/2019 Workflow Improvement
32/44
Reduce Variability Doctor
Face Time
8/11/2019 Workflow Improvement
33/44
Reduce Variability Doctor
Face Time
8/11/2019 Workflow Improvement
34/44
Reduce Variability Doctor
Face Time
8/11/2019 Workflow Improvement
35/44
Reduce Mean Doctor Face
Time
8/11/2019 Workflow Improvement
36/44
Reduce Mean Doctor Face
Time
8/11/2019 Workflow Improvement
37/44
Reduce Mean Doctor Face
Time
8/11/2019 Workflow Improvement
38/44
Reduce Mean Doctor Face
Time
8/11/2019 Workflow Improvement
39/44
Offset Appointment
Schedule
8/11/2019 Workflow Improvement
40/44
Offset Appointment
Schedule
8/11/2019 Workflow Improvement
41/44
Offset AppointmentSchedule
8/11/2019 Workflow Improvement
42/44
Effect of Reducing No-Shows
8/11/2019 Workflow Improvement
43/44
Effect of Reducing No-Shows
8/11/2019 Workflow Improvement
44/44
Effect of Reducing No-Shows
Top Related