PATIENT FLOW: FOLLOW – UP REPORT

Agoncillo, Asperas, Cosalan, Tanbonliong

ASMIP 2009

BACKGROUND

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.

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

• 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

• Assess the recommendations from the previous study

• Provide recommendations that will improve the waiting lines and patient flow

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

SCOPE AND LIMITATIONS

• Study is based on changes made by a previous study conducted last year

• Statistical data from June 2008 to May 2009

DATA COLLECTION

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

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

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

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

ROOM USE

• All 5 rooms are timed according to usage

• Availability of the rooms is an important factor to the patient’s waiting time

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

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

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

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

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

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

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

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

PATIENT VOLUME BY AGE GROUP

PER MONTH

AGE GROUP TOTAL0 – 18 2738

19 – 59 20689

60 AND ABOVE 10493

MISSING DATA 301

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

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

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

GENERAL FLOW OF PATIENTS

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

Previous

Current

New Patient Follow-up Appointment Total

Sample Size 3010 10 10 30

Mean 3:020:12 0:29 0:09 0:16

Median 2:370:13 0:30 0:07 0:15

Std. Deviation 1:320:05 0:12 0:09 0:08

Minimum 1:010:03 0:07 0:01 0:01

Maximum 7:280:19 0:45 0:29 0:45

DATA PROCESSING AT FRONT DESK

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)

GS: Automated Refractometry

PreviousCurrent

Sample Size 3350

Mean 1:050:59

Median 1:080:50

Std. Deviation 0:22

0:28

Minimum 0:300:25

Maximum 2:052:28

Increase in standard deviation and range of values

Mean and median decreased

Increase in dispersion can be attributed to the increase in sample size

GS: AIR PUFF TONOMETRY

PreviousCurrent

Sample Size 34

50

Mean 0:410:35

Median 0:330:35

Std. Deviation 0:20

0:10

Minimum 0:200:19

Maximum 1:531:06

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

GS: CORNEAL TOPOGRAPHY

PreviousCurrent

Sample Size 3250

Mean 1:492:05

Median 1:361:56

Std. Deviation 0:46

1:02

Minimum 0:590:31

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

GS: SPECULAR MICROSCOPY

PreviousCurrent

Sample Size 32 50

Mean 1:42 1:38

Median 1:44 1:33

Std. Deviation 0:44

0:30

Minimum 0:30 0:50

Maximum 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

OPTOMETRIST ROOM USE

PreviousCurrent

Sample Size 5050

Mean 06:0306:12

Median 06:0006:07

Std. Deviation 02:38

02:32

Minimum 01:0001:00

Maximum 13:0015:00

A high standard deviation from both studies

Optometrist may take as long as 15min and as short as 1 min

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

OPTHALMOLOGIST ROOM USE

Previous Current

Sample Size 50 50

Mean 06:47 06:52

Median 06:50 06:43Std. Deviation 04:03 03:22

Minimum 01:00 01:00

Maximum 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

ROOM UTILITY

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

• 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

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

• 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

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

• 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 - 1:59

Room 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

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)

• 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)

– 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

– 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

• 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

• 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)

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

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