Tufts University School of Medicine, Boston, Massachusetts, USA.
Lahey Hospital & Medical Center, Peabody, Massachusetts, USA.
BMC Ophthalmol. 2021 May 10;21(1):206. doi: 10.1186/s12886-021-01955-x.
COVID-19, a highly contagious respiratory virus, presents unique challenges to ophthalmology practice as a high-volume, office-based specialty. In response to the COVID-19 pandemic, many operational changes were adopted in our ophthalmology clinic to enhance patient and provider safety while maintaining necessary clinical operations. The aim of this study was to evaluate how measures adopted during the pandemic period affected retina clinic performance and patient satisfaction, and to model future clinic flow to predict operational performance under conditions of increasing patient and provider volumes.
Clinic event timestamps and demographics were extracted from the electronic medical records of in-person retina encounters from March 15 to May 15, 2020 and compared with the same period in 2019 to assess patient flow through the clinical encounter. Patient satisfaction was evaluated by Press Ganey patient experience surveys obtained from randomly selected outpatient encounters. A discrete-events simulation was designed to model the clinic with COVID-era restrictions to assess operational performance under conditions of increasing patient and provider volumes.
Retina clinic volume declined by 62 % during the COVID-19 health emergency. Average check-in-to-technician time declined 79 %, total visit length declined by 46 %, and time in the provider phase of care declined 53 %. Patient satisfaction regarding access nearly doubled during the COVID-period compared with the prior year (p < 0.0001), while satisfaction with overall care and safety remained high during both periods. A model incorporating COVID-related changes demonstrated that wait time before rooming reached levels similar to the pre-COVID era by 30 patients-per-provider in a 1-provider model and 25 patients-per-provider in a 2-provider model (p < 0.001). Capacity to maintain distancing between patients was exceeded only in the two 2-provider model above 25 patients-per-provider.
Clinic throughput was optimized in response to the COVID-19 health emergency. Modeling these clinic changes can help plan for eventual volume increases in the setting of limits imposed in the COVID-era.
COVID-19 是一种高度传染性的呼吸道病毒，作为一个高容量的、基于办公室的专业，给眼科实践带来了独特的挑战。为了应对 COVID-19 大流行，我们的眼科诊所采取了许多运营变革，以提高患者和医护人员的安全性，同时维持必要的临床运营。本研究旨在评估大流行期间采取的措施如何影响视网膜诊所的绩效和患者满意度，并建立未来的诊所流量模型，以预测在患者和医护人员数量增加的情况下的运营绩效。
从 2020 年 3 月 15 日至 5 月 15 日的现场视网膜就诊的电子病历中提取诊所事件时间戳和人口统计学信息，并与 2019 年同期进行比较，以评估临床就诊的患者流程。通过从随机选择的门诊就诊中获得的 Press Ganey 患者体验调查评估患者满意度。设计了一个离散事件模拟，以在 COVID 时代的限制下对诊所进行建模，以评估在患者和医护人员数量增加的情况下的运营绩效。
COVID-19 卫生紧急情况下，视网膜诊所的就诊量下降了 62%。平均从登记到技术员的时间减少了 79%，总就诊时间减少了 46%，医护人员照护阶段的时间减少了 53%。与前一年相比，COVID 期间患者对就诊的满意度几乎翻了一番（p<0.0001），而在两个时期，患者对整体护理和安全性的满意度都很高。纳入 COVID 相关变化的模型表明，在 1 名医护人员模式下，当每增加 30 名患者/医护人员时，在诊室前的等待时间就会达到与 COVID 前类似的水平，在 2 名医护人员模式下，每增加 25 名患者/医护人员时就会达到这一水平（p<0.001）。只有在上述 2 名医护人员模式下，当每增加 25 名患者/医护人员时，才能超过患者之间保持距离的能力上限。
诊所吞吐量在 COVID-19 卫生紧急情况下得到了优化。对这些诊所变化进行建模可以帮助规划在 COVID 时代限制下的最终容量增加。
