| Title | Redesign of a university hospital preanesthesia evaluation clinic using a queuing theory approach. | | Author(s) | Zonderland ME, Boer F, Boucherie RJ, de Roode A, van Kleef JW | | Institution | Division I, Leiden University Medical Center, Leiden, The Netherlands. m.e.zonderland@lumc.n | | Source | Anesth Analg 2009 Nov; 109(5):1612-21. | | MeSH | Adolescent
Adult
Anesthesia Department, Hospital
Appointments and Schedules
Decision Support Techniques
Efficiency, Organizational
Health Services Needs and Demand
Health Services Research
Hospitals, University
Humans
Length of Stay
Medical Records Systems, Computerized
Medical Staff, Hospital
Models, Organizational
Office Visits
Organizational Objectives
Outpatient Clinics, Hospital
Personnel Staffing and Scheduling
Program Development
Program Evaluation
Reproducibility of Results
Time Factors
Time and Motion Studies
Young Adult
| | Abstract | BACKGROUND: Changes in patient length of stay (the duration of 1 clinic visit) as a result of the introduction of an electronic patient file system forced an anesthesia department to change its outpatient clinic organization. In this study, we sought to demonstrate how the involvement of essential employees combined with mathematical techniques to support the decision-making process resulted in a successful intervention.
METHODS: The setting is the preanesthesia evaluation clinic (PAC) of a university hospital, where patients consult several medical professionals, either by walk-in or appointment. Queuing theory was used to model the initial set-up of the clinic, and later to model possible alternative designs. With the queuing model, possible improvements in efficiency could be investigated. Inputs to the model were patient arrival rates and expected service times with clinic employees, collected from the clinic's logging system and by observation. The performance measures calculated with the model were patient length of stay and employee utilization rate. Supported by the model outcomes, a working group consisting of representatives of all clinic employees decided whether the initial design should be maintained or an intervention was needed.
RESULTS: The queuing model predicted that 3 of the proposed alternatives would result in better performance. Key points in the intervention were the rescheduling of appointments and the reallocation of tasks. The intervention resulted in a shortening of the time the anesthesiologist needed to decide upon approving the patient for surgery. Patient arrivals increased sharply over 1 yr by more than 16%; however, patient length of stay at the clinic remained essentially unchanged. If the initial set-up of the clinic would have been maintained, the patient length of stay would have increased dramatically.
CONCLUSIONS: Queuing theory provides robust methods to evaluate alternative designs for the organization of PACs. In this article, we show that queuing modeling is an adequate approach for redesigning processes in PACs. | | Language | eng | | Pub Type(s) | Journal Article
| | PubMed ID | 19843799 |
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