Singman Eric L, Haberman Chantal V, Appelbaum Jeffrey, Tian Jing, Shafer Karen, Toerper Matthew, Katz Susanne, Kelsay Maureen, Boland Michael V, Greenbaum Milton, Adelman Rebecca, Thomas Richard C, Vakili Sharif
Wilmer Eye Institute (Drs Singman and Boland, Ms Shafer, and Messrs Greenbaum and Thomas) and Division of Health Sciences Informatics (Dr Boland), Johns Hopkins University School of Medicine, Baltimore, Maryland (Mr Vakili); Ophthalmology Department, Northwestern University, Chicago, Illinois (Ms Haberman); Operations Integration, Johns Hopkins Health System, Baltimore, Maryland (Messrs Appelbaum and Toerper and Ms Adelman); Johns Hopkins School of Public Health, Baltimore, Maryland (Ms Tian); Pediatric Emergency Department (Ms Katz) and Emergency Medicine Department (Mr Toerper), Johns Hopkins Hospital, Baltimore, Maryland; and Johns Hopkins Health System, Baltimore, Maryland (Ms Kelsay).
Qual Manag Health Care. 2015 Oct-Dec;24(4):190-9. doi: 10.1097/QMH.0000000000000075.
Real-time location systems (RTLS) and Lean management approaches have been employed to improve patient flow in clinical settings. This study explored the feasibility of using these methodologies in an outpatient resident ophthalmology clinic.
Patients, providers, and staff in Wilmer Eye Institute General Eye Services Clinic were provided RTLS tags to track their movement throughout the clinic after observational studies modeling flow were conducted. Tracking data guided changes for clinic processes based on Lean management approaches, including reorganization of the reception desk, consolidation of forms, creation of task sheets to improve communication, installation of door flags on examination rooms, and training the staff in service excellence. Tracking was repeated after changes were implemented. A patient satisfaction survey was also conducted prior to and after the changes.
After intervention, significant increases were measured in the average time patients spent in the clinic (99.3 minutes vs 112.8 minutes). Significant decreases were seen in the times patients spent with the optometrists (15.4 minutes vs 12.1 minutes), testing (24.7 minutes vs 23.0 minutes), and together with both the attending and the resident (8.3 minutes vs 5.8 minutes). The patient satisfaction survey indicated improvements in patients' perception of the helpfulness/friendliness of the staff, the length of time patients perceived they waited, and overall clinic experience.
Both RTLS and Lean management approaches may be feasible ways to track and improve patient flow and satisfaction if certain limitations can be overcome. This is the first published report describing these approaches applied to an academic ophthalmology clinic in the United States.
实时定位系统（RTLS）和精益管理方法已被用于改善临床环境中的患者流程。本研究探讨了在门诊眼科住院诊所使用这些方法的可行性。
在对威尔默眼科研究所综合眼科服务诊所的患者、医护人员进行流程建模的观察性研究后，为他们提供了RTLS标签，以跟踪他们在整个诊所的活动。跟踪数据指导基于精益管理方法的诊所流程变革，包括前台重组、表格整合、创建任务单以改善沟通、在检查室安装门旗以及对员工进行卓越服务培训。在实施变革后重复进行跟踪。还在变革前后进行了患者满意度调查。
干预后，患者在诊所平均花费的时间显著增加（99.3分钟对112.8分钟）。患者与验光师相处的时间（15.4分钟对12.1分钟）、检查时间（24.7分钟对23.0分钟）以及与主治医生和住院医生一起的时间（8.3分钟对5.8分钟）均显著减少。患者满意度调查表明，患者对工作人员的帮助/友好程度、他们认为等待的时间长度以及整体诊所体验的感知有所改善。
如果能够克服某些限制，RTLS和精益管理方法都可能是跟踪和改善患者流程及满意度的可行方法。这是第一份描述这些方法应用于美国学术眼科诊所的发表报告。
