Karan Sethi1, Emily S Levine1, Shiyoung Roh1,2, Jeffrey L Marx1,2, David J Ramsey3,4. 1. Tufts University School of Medicine, Boston, Massachusetts, USA. 2. Lahey Hospital & Medical Center, Peabody, Massachusetts, USA. 3. Tufts University School of Medicine, Boston, Massachusetts, USA. David.J.Ramsey@lahey.org. 4. Lahey Hospital & Medical Center, Peabody, Massachusetts, USA. David.J.Ramsey@lahey.org.
Abstract
BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
BACKGROUND: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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
Entities:
Keywords:
COVID-19; Discrete‐event simulation; Health Services Research; Outpatient; Patient flow
Authors: Mark P Breazzano; Archana A Nair; J Fernando Arevalo; Mark R Barakat; Audina M Berrocal; Jonathan S Chang; Andrew Chen; Dean Eliott; Sunir J Garg; Quraish Ghadiali; Dan Gong; Dilraj S Grewal; James T Handa; Matthew Henderson; Yannek I Leiderman; Theodore Leng; Amar Mannina; Thomas A Mendel; Debarshi Mustafi; Lisa C Olmos de Koo; Shriji N Patel; Tapan P Patel; Jonathan Prenner; Paige Richards; Rishi P Singh; Charles C Wykoff; Nicolas A Yannuzzi; Hannah Yu; Yasha S Modi; Stanley Chang Journal: JAMA Ophthalmol Date: 2021-04-01 Impact factor: 7.389
Authors: Calvin C Robbins; Sidrah Anjum; Amer Mosa Alwreikat; Michael Lee Cooper; Paul R Cotran; Shiyoung Roh; David J Ramsey Journal: Ophthalmol Sci Date: 2021-09-22