PATIENT FLOW: FOLLOW – UP REPORT

Agoncillo, Asperas, Cosalan, Tanbonliong

ASMIP 2009

BACKGROUND

SIGNIFICANCE OF THE STUDY

• Assess and evaluate the current patient flow system being employed

• Identify weak and strong points of the system• 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 focused on patient flow and waiting times

• Statistical data from June 2008 to May 2009

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 and compare current and previous statistical trends on patient volume according to: – Time interval in a day– Day of the week– Age group– Chart type

• 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

• Assess the recommendations from the previous study

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

STATISTICAL TRENDS: TIME INTERVAL IN A DAY

Average Patient Volume by Time Interval per WeekdayTIME 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

Current Patient Volume by Time Interval per Workday

There is a peak of incoming patients around 9am to 11am that later on decline s during lunch hour and later on peaks again at 1pm.

This is unlike the previous study which shows a steady decrease in the number of incoming patients as the day progresses.

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

Current Patient Volume by Time Interval per Month

Similar to the previous chart on Time Interval per Workday, the table on Time Interval per Month shows a similar trend.

There is an increase in patient volume in the morning, a decrease during lunchtime, and again an increase after lunch at around 1pm

Back to objectives

STATISTICAL TRENDS: DAY OF THE WEEK

WEEKDAY ASMIP 2008 ASMIP 2009

Monday 117 114

Tuesday 135 137

Wednesday 109 112

Thursday 105 116

Friday 134 139

Saturday 148 156

Average Patient Volume by Weekday

There has been an increase on the average number of patients this year as comparedto last year.

The trend on the busiest and slowest days of the week remain the same however with Saturday as having the most number of patients and Wednesday having the least.

The trend may be due to the schedule of surgeries and consultations that are have a specific schedule in the week and the presence or absence of the physicians.

Back to objectives

STATISTICAL TRENDS: AGE GROUPPatient Volume by Age Group per Month

AGE GROUP TOTAL0 – 18 2738

19 – 59 20689

60 AND ABOVE 10493

MISSING DATA 301

Majority of patients come from the19 – 59 age group.

Patients from the 60 and above agegroup are the next most numeroussince the clinic offers procedures torepair cataracts

Patient Volume by Age Group per Day of the 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

Back to objectives

There has been a noted decrease in patientsfrom the 19 – 59 age group and an increase in the 60 and above age group this year.

This increase in the number of senior citizens may be due to the increasing popularity of cataract treatment services provided for by the clinic

STATISTICAL TRENDS: CHART TYPEPatient Volume by Chart Type per Month

CHART TYPE

ASMIP 2008

ASMIP 2009

GC 661 794

FF 1689 1956

LS 162 132

SX 221 231

It is seen from the chart and table that majority of patients go to the clinic for follow – up sessions.

This is understandable since patients that undergo surgeries must return to the clinic repetitively for Observation.

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

Back to objectives

Saturday is considered the busiest day despite the shorter working time and lack of surgeriesthus the day is mostly devoted to follow – up and consultations.

GENERAL FLOW

PATIENT DATA PROCESSING AT FRONT DESK

Previous

Current

New Patient Follow-up Appointment Total

Sample Size 30 10 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 7:28 0:19 0:45 0:29 0:45

A marked decrease in the processing time was observed from 3 min and 2 seconds last yearto 16 seconds this year.

This drastic decrease is attributed to the SmartQ system that is being implemented. Althoughthis system was already in effect last year, it was still very new. Thus, the staff may have still been unfamiliar with the system last year and this year are already very familiar and used to it.

TURNOVER FROM CHART BOX TO OPTOMETRIST

0:00

0:14

0:28

0:43

0:57

1:12

1:26

Turnover from Chart Box to Optometrist

Time

Tota

l Tim

e

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

0:00:00

0:14:24

0:28:48

0:43:12

0:57:36

1:12:00

1:26:24

Time from chart box to optometrist

Series1Polynomial (Series1)

Time

Tota

l tim

e

Previous Study

Current StudyThis shows the time it takes for thecharts to be picked up by the optometrists.

There is an increase in duration at around 11:30am and reached its peak at 1:00pm.

The initial increase may be attributedTo the surge of patients that came inDuring the morning while the secondIncrease may be due to the decrease in Number of optometrists since most Of them have their lunch at this time.

The current study shows a decrease in duration as the day progresses unlike the previous study that shows the steady increase in duration until the clinic closes.

GENERAL SCREENINGSPrevious Current

Sample Size 33 50

Mean 1:05 0:59

Median 1:08 0:50

Std. Deviation 0:22 0:28

Minimum 0:30 0:25

Maximum 2:05 2:28

Automated Refractometry

Previous CurrentSample Size 34 50Mean 0:41 0:35Median 0:33 0:35

Std. Deviation 0:20 0:10Minimum 0:20 0:19Maximum 1:53 1:06

Air Puff Tonometry

Previous Current

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 4:09 5:31

Corneal Topography

Previous Current

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

Specular Microscopy

OPTOMETRIST ROOM USE

Previous Current

Sample Size 50 50

Mean 06:03 06:12

Median 06:00 06:07Std. Deviation 02:38 02:32

Minimum 01:00 01:00

Maximum 13:00 15:00

The results for optometrist room use lastyear compared to this year is very similar.

The results show a room use that rangesfrom 1min to 15 min with an average ofaround 6 min.

The optometrists use the room to performnumerous tests to the patient and explainsprocedures which accounts for the long room use time.

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 or for the doctor to finish with his preceding patients

There is a significant decrease in waiting time which means that there is a more efficient usage of rooms.

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

There is no significant difference in last year’s time from this year’s time.

Back to objectives

ROOM UTILITY

CATARACT SURGERY DAY: MAY 26Room 1 0:07

Room 2 0:07

Room 3 0:08

Room 4 0:09

Room 5 0:11

Average 0:08

Cataract surgery days are usually on Tuesdays and Thursdays.

The average duration is 8min with the shortest time of 5min and the longest time of 43 min showing a large range.

This long time may be due to elderly patients who consult long with physicians dueto their cataract surgeries.

• 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 29Room 1 0:05

Room 2 0:12

Room 3 0:09

Room 4 0:11

Room 5 0:11

Average 0:09

LASIK surgeries are scheduled every Monday and Friday.

There is an average waiting time of 9min with the shortest time being 7min and the Longest time being 14min.

The smaller range in the results is indicative that there are more patients in the working group than in the elderly and children group since the working group are usually

the ones who opt for LASIK surgery.

• 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 30Room 1 0:05Room 2 0:08Room 3 0:12Room 4 0:09Room 5 0:10Average 0:08

Saturday is the busiest day of the week of the clinic. Most of the cases here are follow – up consultations and there is an increased number of pediatric aged patients during Saturday.

The average time is 8min with a range of 3min being the shortest time and 24min as thelongest time.

According to interviews, the long time may be attributed to pediatric patients who are sometimes difficult to perform tests to.

• 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

AVERAGE ROOM VACANCY IN 1 DAYPrevious Current

Room 1 216 98Room 2 197 123Room 3 172 132Room 4 229 120Room 5 214 70Average 206 109

Significant decrease in time of room vacancy this year compared to last year which means that there is a moreefficient usage of rooms and they are not left empty.

Therefore there is also a decrease in the turnover time Of patients from optometrists to opthalmologists.

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)

RECOMMENDATIONS• Adhere to an appointment based institution • Scheduled breaks of optometrists• Maintain a standard 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