Department of Ophthalmology & Visual Sciences, University of Michigan Medical School, 1000 Wall St, Ann Arbor, MI, 48105, USA.
Department of Industrial and Operations Engineering, University of Michigan, Ann Arbor, MI, USA.
BMC Ophthalmol. 2022 Jun 28;22(1):283. doi: 10.1186/s12886-022-02495-8.
Lean methodology helps maximize value by reducing waste, first by defining what value and waste are in a system. In ophthalmology clinics, value is determined by the number of patients flowing through the clinic for a given time. We aimed to increase value using a lean-methodology guided policy change, then assessed its impact on clinic flow using an automated radiofrequency identification (RFID) based real-time locating system (RTLS).
A total of 6813 clinical visits occurred at a single academic institution's outpatient glaucoma clinic between January 5, 2018 to July 3, 2018. Over that period, 1589 patients comprising 1972 (29%) of visits were enrolled, with 1031 clinical visits occurring before and 941 visits after a policy change. The original policy was to refract all patients that improved with pinhole testing. The policy change was not to refract patients with a visual acuity ≥20/30 unless a specific request was made by the patient. Pre-post analysis of an automated time-motion study was conducted for the data collected 3 months before and 3 months after the policy change occurred on March 30, 2018. Changes to process and wait times were summarized using descriptive statistics and fitted to linear mixed regression models adjusting for appointment type, clinic volume, and daily clinic trends.
One thousand nine hundred twenty-three visits with 1588 patients were included in the analysis. Mean [SD] age was 65.9 [14.7] years and 892 [56.2%] were women. After the policy change, technician process time decreased by 2.9 min (p < 0.0001) while daily clinical patient volume increased from 51.9 ± 16.8 patients to 58.4 ± 17.4 patients (p < 0.038). No significant difference was found in total wait time (p = 0.18) or total visit time (p = 0.83).
Real-time locating systems are effective at capturing clinical flow data and assessing clinical practice change initiatives. The refraction policy change was associated with reduced technician process time and overall the clinic was able to care for 7 more patients per day without significantly increasing patient wait time.
精益方法通过首先定义系统中的价值和浪费，帮助最大化价值。在眼科诊所，价值是由给定时间内通过诊所的患者数量决定的。我们旨在使用精益方法指导的政策变更来增加价值，然后使用基于自动射频识别 (RFID) 的实时定位系统 (RTLS) 评估其对诊所流量的影响。
2018 年 1 月 5 日至 2018 年 7 月 3 日期间，一家学术机构的门诊青光眼诊所共进行了 6813 次临床就诊。在此期间，共纳入 1589 名患者的 1972 次就诊（29%），其中政策变更前进行了 1031 次就诊，政策变更后进行了 941 次就诊。最初的政策是对所有通过针孔测试改善的患者进行折射。政策变更为除非患者有特定要求，否则不折射视力≥20/30 的患者。在 2018 年 3 月 30 日政策变更后 3 个月和之前 3 个月收集的数据进行了自动时间运动研究的前后分析。使用描述性统计和拟合线性混合回归模型总结过程和等待时间的变化，调整预约类型、诊所量和每日诊所趋势。
共纳入 1588 名患者的 1923 次就诊进行了分析。平均[SD]年龄为 65.9[14.7]岁，892[56.2%]为女性。政策变更后，技术员处理时间减少了 2.9 分钟（p<0.0001），而每日临床患者量从 51.9[±16.8]例增加到 58.4[±17.4]例（p<0.038）。总等待时间（p=0.18）或总就诊时间（p=0.83）无显著差异。
实时定位系统有效地捕获临床流量数据并评估临床实践变更计划。折射政策的变更与技术员处理时间的减少有关，总体而言，该诊所每天能够多照顾 7 名患者，而不会显著增加患者等待时间。
