Center for Healthcare Operations Improvement and Research (CHOIR), University of Twente, Drienerlolaan 5, Enschede, The Netherlands.
Department of Internal Medicine, Isala, Zwolle, The Netherlands.
BMC Health Serv Res. 2024 Sep 28;24(1):1145. doi: 10.1186/s12913-024-11615-7.
Outpatient Clinics (OCs) are under pressure because of increasing patient volumes and provider shortages. At the same time, many patients with chronic diseases receive routine follow-up consultations that are not always necessary. These patients block access to care for patients that are in actual need for care. Pre-assessing patient charts has shown to reduce unnecessary outpatient visits. However, the resulting late cancellations due to the pre-assessment, challenge efficient alignment of capacity with actual patient demand, leading to either empty slots or overtime. This study aims to develop a method to analyse the effect of pre-assessing patients before inviting them to the OC. This involves 1) to select who should come and 2) to optimize the impact of pre-assessment on the schedule and efficient use of OC staff.
This prospective mixed-methods evaluation study consists of 1) an expert meeting to determine a pre-assessment strategy; 2) a retrospective cohort study to review the impact of this strategy (12 months of a Dutch nephrology OC); 3) mathematical optimization to develop an optimal criteria-based scheduling strategy; and 4) a computer simulation to evaluate the developed strategy. Primary outcomes are the staff idle time and staff overtime. Secondary outcomes evaluate the number of weekly offered appointments.
The expert group reached consensus about the pre-assessment criteria. 875 (18%) of the realized appointments in 2022 did not meet the OC visit pre-assessment criteria. In the best performing scheduling strategy, 94 slots (87% of the available capacity) should be scheduled on a weekly basis. For this schedule, 26.8% of the OC weeks will experience idle time ( =2.51, =1.44 appointment slots), and 21% of the OC weeks will experience overtime ( =2.26, =1.65 appointment slots) due to the variation in patient appointment requests. Using the pre-assessment strategy combined with the best performing scheduling strategy under full capacity (108 slots), up to 20% increase in patient demand can be handled with equal operational performance.
This evaluation study allows OC managers to virtually test operational impact of pre-assessment strategies on the capacity of their OC, and shows the potential of increasing efficient use of scarce healthcare capacity.
Not applicable.
由于患者数量增加和医务人员短缺，门诊（OC）面临压力。与此同时，许多慢性病患者接受常规随访咨询，但这些咨询并非总是必要的。这些患者阻碍了真正需要护理的患者获得护理的机会。预先评估患者病历已被证明可以减少不必要的门诊就诊。然而，由于预评估而导致的后续取消预约，对高效调整能力与实际患者需求的匹配造成了挑战，导致出现空位或加班。本研究旨在开发一种方法，以分析在邀请患者到 OC 之前对其进行预评估的效果。这涉及到 1）选择谁应该来，以及 2）优化预评估对日程安排和 OC 工作人员高效使用的影响。
这是一项前瞻性混合方法评估研究，包括 1）专家会议，以确定预评估策略；2）回顾性队列研究，以评估该策略的影响（荷兰肾脏病学 OC 的 12 个月）；3）数学优化，以制定最佳基于标准的调度策略；以及 4）计算机模拟，以评估所开发的策略。主要结果是工作人员空闲时间和工作人员加班时间。次要结果评估每周提供的预约数量。
专家组就预评估标准达成共识。在 2022 年实现的 875 次预约（占 18%）不符合 OC 就诊预评估标准。在表现最佳的调度策略中，每周应安排 94 个预约（占可用容量的 87%）。对于该时间表，由于患者预约请求的变化，94%的 OC 周将出现空闲时间（ =2.51， =1.44 个预约插槽），21%的 OC 周将出现加班（ =2.26， =1.65 个预约插槽）。使用预评估策略结合最佳表现调度策略，在满负荷（108 个插槽）下，可处理多达 20%的患者需求增长，而运营绩效保持不变。
这项评估研究使 OC 经理能够虚拟测试预评估策略对其 OC 能力的运营影响，并展示了增加稀缺医疗保健能力高效利用的潜力。
不适用。
