Johns Hopkins School of Medicine, Department of Radiation Oncology and Molecular Radiation Sciences, Baltimore, Maryland.
Johns Hopkins Carey Business School, Baltimore, Maryland.
Pract Radiat Oncol. 2018 Sep-Oct;8(5):317-323. doi: 10.1016/j.prro.2018.04.015. Epub 2018 May 5.
Common performance metrics for outpatient clinics define the time between patient arrival and entry into an examination room as "waiting time." Time spent in the room is considered processing time. This characterization systematically ignores time spent in the examination room waiting for service. If these definitions are used, performance will consistently understate total waiting times and overstate processing times. Correcting such errors will provide a better understanding of system behavior.
In a radiation oncology service in an urban academic clinic, we collected data from a patient management system for 84 patients with 4 distinct types of visits: consultations, follow-ups, on-treatment visits, and nurse visits. Examination room entry and exit times were collected with a real-time location system for relevant care team members. Novel metrics of clinic performance were created, including the ratio of face time (ie, time during which the patient is with a practitioner) to total cycle time, which we label face-time efficiency. Attending physician interruptions occurred when the attending is called out of the room during a patient visit, and coordination-related delays are defined as waits for another team member.
Face-time efficiency levels for consults, follow-ups, on-treatment visits, and nurse visits were 30.1%, 22.9%, 33.0%, and 25.6%, respectively. Attending physician interruptions averaged 6.7 minutes per patient. If these interruptions were eliminated, face-time efficiencies would rise to 33.2%, 29.2%, 34.4%, and 25.6%, respectively. Eliminating all coordination-related delays would increase these values to 41.3%, 38.9%, 54.7%, and 38.7%, respectively.
A real-time location system can be used to augment a patient management system and automate data collection to provide improved descriptions of clinic performance.
门诊的常见绩效指标将患者到达和进入诊室之间的时间定义为“等待时间”。在房间内花费的时间被视为处理时间。这种描述系统地忽略了在检查室等待服务所花费的时间。如果使用这些定义，那么绩效将始终低估总等待时间并高估处理时间。纠正这些错误将有助于更好地了解系统行为。
在城市学术诊所的放射肿瘤学服务中，我们从患者管理系统中收集了 84 名患者的 4 种不同类型就诊的数据：咨询、随访、治疗就诊和护士就诊。使用实时定位系统收集相关护理团队成员的诊室进入和离开时间。创建了新的诊所绩效指标，包括面对面时间（即患者与医生在一起的时间）与总周期时间的比率，我们将其标记为面对面效率。当主治医生在患者就诊期间被叫出房间时，就会发生主治医生的中断，而协调相关的延迟则定义为等待另一名团队成员的时间。
咨询、随访、治疗就诊和护士就诊的面对面效率水平分别为 30.1%、22.9%、33.0%和 25.6%。主治医生的中断平均为每位患者 6.7 分钟。如果消除这些中断，面对面效率将分别提高到 33.2%、29.2%、34.4%和 25.6%。消除所有协调相关的延迟将使这些值分别增加到 41.3%、38.9%、54.7%和 38.7%。
实时定位系统可用于增强患者管理系统并自动收集数据，以提供对诊所绩效的改进描述。
