Using patient flow analysis with real-time patient tracking to optimize radiation oncology consultation visits

• Published in: BMC health services research Vol. 22; no. 1; p. 1517
• Main Authors: Mesko, Shane, Weng, Julius, Das, Prajnan, Koong, Albert C, Herman, Joseph M, Elrod-Joplin, Dorothy, Kerr, Ashley, Aloia, Thomas, Frenzel, John, French, Katy E, Martinez, Wendi, Recinos, Iris, Alshaikh, Abdulaziz, Daftary, Utpala, Moreno, Amy C, Nguyen, Quynh-Nhu
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 13.12.2022; BioMed Central; BMC
• Subjects: Ambulatory Care Facilities; Cancer patients; Cancer therapies; Care and treatment; Clinical efficiency; Clinical workflow; Cycle time; Data collection; Dosage and administration; Efficiency; Efficiency, Organizational; Health care; Health care management; Health services; Humans; Nurses; Oncology; Patient assessment; Patient education; Patient flow analysis; Patient Identification Systems; Patient Satisfaction; Physicians; Protons; Quality improvement; Radiation; Radiation Oncology; Radiotherapy; Referral and Consultation; Rooming time; Vital signs; Waiting time; United States; United States > US; Patient flow analysis; Radiation oncology; Rooming time; Clinical workflow; Waiting time; Clinical efficiency; Cycle time
• ISSN: 1472-6963; 1472-6963
• DOI: 10.1186/s12913-022-08809-2

Clinical efficiency is a key component of the value-based care model and a driver of patient satisfaction. The purpose of this study was to identify and address inefficiencies at a high-volume radiation oncology clinic. Patient flow analysis (PFA) was used to create process maps and optimize the workflow of consultation visits in a gastrointestinal radiation oncology clinic at a large academic cancer center. Metrics such as cycle times, waiting times, and rooming times were assessed by using a real-time patient status function in the electronic medical record for 556 consults and compared between before vs after implementation of the PFA recommendations. The initial PFA revealed four inefficiencies: (1) protracted rooming time, (2) inefficient communications, (3) duplicated tasks, and (4) ambiguous clinical roles. We analyzed 485 consult-visits before the PFA and 71 after the PFA. The PFA recommendations led to reductions in overall median cycle time by 21% (91 min vs 72 min, p < 0.001), in cumulative waiting times by 64% (45 min vs 16 min; p < 0.001), which included waiting room time (14 min vs 5 min; p < 0.001) and wait for physician (20 min vs. 6 min; p < 0.001). Slightly less than one-quarter (22%) of consult visits before the PFA lasted > 2 h vs. 0% after implementation of the recommendations (p < 0.001). Similarly, the proportion of visits requiring < 1 h was 16% before PFA vs 34% afterward (p < 0.001). PFA can be used to identify clinical inefficiencies and optimize workflows in radiation oncology consultation clinics, and implementing their findings can significantly improve cycle times and waiting times. Potential downstream effects of these interventions include improved patient experience, decreased staff burnout, financial savings, and opportunities for expanding clinical capacity.