Analytical models to determine room requirements in outpatient clinics

Outpatient clinics traditionally organize processes such that the doctor remains in a consultation room while patients visit for consultation, we call this the Patient-to-Doctor policy (PtD-policy). A different approach is the Doctor-to-Patient policy (DtP-policy), whereby the doctor travels between multiple consultation rooms, in which patients prepare for their consultation. In the latter approach, the doctor saves time by consulting fully prepared patients. We use a queueing theoretic and a discrete-event simulation approach to provide generic models that enable performance evaluations of the two policies for different parameter settings. These models can be used by managers of outpatient clinics to compare the two policies and choose a particular policy when redesigning the patient process.We use the models to analytically show that the DtP-policy is superior to the PtD-policy under the condition that the doctor’s travel time between rooms is lower than the patient’s preparation time. In addition, to calculate the required number of consultation rooms in the DtP-policy, we provide an expression for the fraction of consultations that are in immediate succession; or, in other words, the fraction of time the next patient is prepared and ready, immediately after a doctor finishes a consultation. We apply our methods for a range of distributions and parameters and to a case study in a medium-sized general hospital that inspired this research

Health care operations management

Health care operations management has become a major topic for health care service providers and society. Operations research already has and further will make considerable contributions for the effective and efficient delivery of health care services. This special issue collects seven carefully selected papers dealing with optimization and decision analysis problems in the field of health care operations management

Taxonomic classification of planning decisions in health care: a review of the state of the art in OR/MS

We provide a structured overview of the typical decisions to be made in resource capacity planning and control in health care, and a review of relevant OR/MS articles for each planning decision. The contribution of this paper is twofold. First, to position the planning decisions, a taxonomy is presented. This taxonomy provides health care managers and OR/MS researchers with a method to identify, break down and classify planning and control decisions. Second, following the taxonomy, for six health care services, we provide an exhaustive specification of planning and control decisions in resource capacity planning and control. For each planning and control decision, we structurally review the key OR/MS articles and the OR/MS methods and techniques that are applied in the literature to support decision making

Efficiency evaluation for pooling resources in health care

Hospitals traditionally segregate resources into centralized functional departments such as diagnostic departments, ambulatory care centers, and nursing wards. In recent years this organizational model has been challenged by the idea that higher quality of care and efficiency in service delivery can be achieved when services are organized around patient groups. Examples include specialized clinics for breast cancer patients and clinical pathways for diabetes patients. Hospitals are struggling with the question of whether to become more centralized to achieve economies of scale or more decentralized to achieve economies of focus. In this paper we examine service and patient group characteristics to study the conditions where a centralized model is more efficient, and conversely, where a decentralized model is more efficient. This relationship is examined analytically with a queuing model to determine themost influential factors and then with simulation to fine-tune the results. The tradeoffs between economies of scale and economies of focus measured by these models are used to derive general management guidelines

AN ASSESSMENT OF OUTPATIENT CLINIC ROOM VENTILATION SYSTEMS AND POSSIBLE RELATIONSHIP TO DISEASE TRANSMISSION

The delivery of healthcare in the United States is shifting from a largely inpatient model to an outpatient services model, but the physical infrastructure for outpatient clinics or medical offices may not be as robust as inpatient hospitals regarding whole room ventilation requirements. Guidelines for the design of healthcare facilities and national standards for ventilation establish generally acceptable ventilation rates for outpatient clinics, but it is unclear if these standards are actually being integrated into these settings. Published peer reviewed literature indicates that inadequate ventilation rates can be a risk factor in airborne transmission of infectious diseases in outpatient clinics, hospitals and residential buildings. This study examined whether outpatient clinics operating in a business occupancy setting were conducting procedures in rooms with ventilation rates above, at, or below thresholds defined in ANSI/ASHRAE/ASHE Standard 170 for Ventilation in Health Care Facilities, and whether lower ventilation rate and building characteristics increase the risk of transmission of infectious disease. Ventilation rates were measured in outpatient clinic rooms categized by services rendered (general exam, treatment or procedure room; aerosol-generating or minor surgical procedures) to compare against national standards. Analysis included evaluation of the building characteristics (where the clinic resides) as determinants of ventilation rates and estimated risk of infectious disease transmission based on the measured ventilation rates. The results of this study suggest that a subset of clinics operating in business occupancy settings may be conducting procedures in rooms with ventilation rates that are below those defined in national standards for healthcare settings. When compared to the ANSI/ASHRAE/ASHE Standard 170 for Ventilation in Health Care Facilities standards, 11 of the 105 (10%) clinic rooms assessed did not meet the minimum requirement for general exam rooms, 41 of 105 (39%) did not meet the requirement for treatment rooms, 87 of 105 (83%) did not meet the requirement for aerosol-generating procedures, and 92 of 105 (88%) did not meet the requirement for procedure rooms or minor surgical procedures. While lower air change rates were observed in all building types, newer constructed one-story stand-alone buildings exhibited higher air change rates as compared to the other building types. Based on the measured ventilation rates and the procedures being performed, these outpatient clinic rooms could possibly facilitate transmission of infectious disease rather than protect workers and patients. National ventilation standards should be considered for all healthcare settings and factored into clinic design and clinic lease agreements, which is currently not the case, as suggested by the evidence in this study

Paying for Language Services in Medicare: Preliminary Options and Recommendations

Discusses how the federal government could design payment systems for language services in Medicare, and offers preliminary recommendations for implementing such programs

Re-engineering the outpatient process flow of a multi-speciality hospital

Manufacturing concepts such as Just-in-Time, Lean and Six-Sigma, Japanese 5S, Materials Requirement Planning, Scheduling and Capacity Management have been applied in the Healthcare industries in the West for the last decade and has yielded positive results. In this study, these concepts and philosophies have been applied to an Indian Multi-speciality Hospital to improve its OPD process flow and increase patient satisfaction. The Outpatients Department (OPD) is usually the most crowded sector in a hospital. The frequent problems encountered include the waiting period for consultation, an unpredictable number of Walk-in patients, insufficient and operationally deficient OPD reception staff and unattended appointment patients. This study aims at, identifying methods to standardise OPD operations management. It has made the process more efficient through optimum resource utilisation. This will increase patient satisfaction by meeting and exceeding their expectations while maintaining quality of care. This research was conducted by mapping the process flow and using the data that was collected through an observational, cross-sectional, non-interventional study. Though there were a comprehensive set of recommendations at the end of the study, only a few could be implemented due to the introduction of a new Hospital Information System (HIS) software putting the implementation plan on hold

Logistics performances of health care system using queue analysis

As there is a very high demand for health service that exceeds the available capacity, the public healthcare centers are overwhelmed with the long queues or they are delivering the service with relatively very low consultation time. In the existing conditions, patients go as early as they can to the healthcare facilities, waiting in queue, even before the opening and had to wait long time for examination, consultation and diagnosis. However, due to high number of patients at the outpatient departments relative to the number of physicians, it results in an increased workload on the physicians and it shortens the patient consultation time, which has an impact on the patients’ health. The main objective of this research was to study the logistic performances of the healthcare system using queuing analysis. This research used three key performance indicators namely, patient queue length, patient waiting time and consultation time length. The performance evaluation was conducted based on data from patients who visited 69 clinical, surgical and diagnosis departments at the outpatient clinics of the hospital. Queue analysis was performed to determine the operational characteristics using a queue scenario with Poisson arrival, exponential service, infinite population, First Comes First Served (FCFS) discipline and multiple server arrangement. The study showed that the patients’ arrival rate highly exceeded the service rate, in each respective clinical department. The outpatient clinics at the SPHMMC achieved an average total waiting time of 92 minutes to get consultation and nearly 70% of the patients waited for more than 95 minutes. The consultation time was as low as 5.71 minute at the Medical clinic and 6.16 minute at the Ophthalmology clinic and around 60% of the patients saw the doctor for a time less than 10 minutes. Therefore, this research recommends addressing the gaps in human resources and logistical supplies, to implement and enforce a staggered patient scheduling and appointment system and to have serious intervention and control on the dual practice, to ensure a smooth clinic process and to reduce waiting times