In response to an effort to reduce total wait times experienced by patients and families by 20%, ease the increasing burdens experienced by medical personnel and staff, meet LHSC and CH standards of customer care and service, and follow government expense protocol and mandate, Pediatric Orthopedics clinics (POC) proposes an improved scheduling process within the clinic, dedication of X-ray equipment during clinic hours, and the addition of senior medical students during clinic hours.
The burden of moving patients through POC in a timely and efficient manner is paramount. Easing this burden will move patients through faster, thus resulting in improved customer service and less missed time at work. This will also ease the burden and pressures CH staff is experiencing on all levels moving patients from POC through the process. An objective to reducing wait times by 20% has been established to show meaningful and purposeful improvement to all parties.
POC is concerned about the amount of time patients are spending in the clinic. On average, patients spend approximately two hours in the clinic. When a patient arrives at the clinic, they are directed to the registration desk where one of three clerks receives and registers the patient. Upon registration, the patient is then asked to wait in the adjacent reception area. While the patient waits, one of three nurses verifies the medical records of the patient and determines the status of their visit for process. If the patient is in the clinic for a follow-up (FUP) appointment that requires no X-ray, the patient is directed to wait until an examination room is available, where they are seen by one or the entire surgeon, senior resident student(s), and/or cast technician. If the patient is in the clinic for a follow-up appointment, or is a new patient (NP), and requires an X-ray, they are directed to the Radiology department registration desk.
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Once in radiology, they are met by one registration clerk who receives and registers the patient for X-ray. Upon registration, the patient is directed to wait in the adjacent radiology reception area. When the next available of six X-ray technicians becomes available, they are escorted to the X-ray room and the technician proceeds to X-ray the patient (there is one X-ray technician per available X-ray machine).
Once the X-ray is complete, the patient is escorted back to the reception and asked to wait while the X-ray film develops and is reviewed by one of three available radiologists. Once the diagnostic review is complete, the patient is hand-delivered the X-ray film and is directed back to the clinic registration desk.
After handing off the film to one of the three available verification nurses at the clinic registration desk, a fourth nurse places the film in the patients file. This nurse is also available to call and direct patients into a given examination room; in addition, this nurse is responsible for examination room prep between patients.
Once called to an examination room, the patient, at some point, sees one or all of the surgeon, senior resident student(s), and/or cast technician. Upon the end of the examination, a patient may perform one or all of the following: return to the clinic registration desk to schedule a future appointment, venture to the hospital cafe, visit the pharmacy, or return home.
The most meaningful and impactful resolution will include that of the identified needs and wants of all stakeholders. In order for POC to achieve its desired goal of a 20% reduction in wait times, easing the burdens of staff, and adhere to budgetary pressures to reduce the cost of service, radiology will need to work in close conjunction with POC and POC staff will need to work smarter, not necessarily harder. There are four available options to reduce the excessive wait times, ease staff tensions, and
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reduce costs, all while resulting in a 20% total wait time reduction.
The first available option is to purchase an additional X-ray machine for the Radiology department at an estimated annual cost of $5,000 in annual maintenance and $75,000 to pay another qualified technician. The estimated capital cost of the new machine is $30,000. At the end of year one, the unaudited investment for one machine will realize $110,000. As a shared resource, the addition of one X-ray machine would increase total available time to POC to 1,120 minutes per day. This would be an excellent addition to the Radiology department and LHSC. As a major medical center, keeping up with the latest technology is important in delivering cutting-edge care. The additional machine would also allow for potentially more patients from other areas of the hospital X-ray availability.
The second option includes the dedicated use of four of the six available machines from the Radiology department allocated to POC during clinic hours. This option certain meets the 2/3 use-time mandated by the hospital to POC from Radiology. In addition, and in an effort to reduce the wait times experienced by patients who differ in X-ray type, from upper- to lower-extremity, the technician setups could be minimized if two of the four machines could be allocated to upper-extremity and the other two machines to lower-extremity. Of course, one or both of the machines could be repurposed to meet the demand if one of the X-ray types is in greater demand during this particular day. Notwithstanding the pressures from Emergency Care, the Urology, and the Chest clinic, if these three-shared resources have the scheduling pressures to meet the use of two machines during clinic hours, this option becomes very appealing.
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Efficient scheduling of patients and placing staff in critical areas at critical times is the crux of the third option. The available times in each phase of the POC process have been established and measured against available staff. There are enough minutes available each day to accommodate the demands of moving 80 patients through POC. Repurposing some staff, reassigning responsibilities to some staff, adding staff at specific stages, these options are all available without the additional expense of needing to hire additional labor. In addition, proper scheduling of patients each day would help keeps the flow constant, but keeps the waters from running over the bulkheads. The surgeon needs immediate attention and the repurposing/reassigning of some staff would immediate ease this burden.
A final option is a limited combination of one or all of the previous three. This is a very reasonable option as only one of the above options moves the budgetary needle, if only temporarily, the wrong direction. Working in concert with, the above options may prove out to be the most proficient decision.
The clear choice is the hybrid. Allocating the dedicated use of the radiology equipment is important, but does not answer the wait times in total, nor does simply shifting the schedules to include an additional senior resident. However, the combination of both meets the three primary concerns and addresses the secondary issues as well. In addition, this is the point: improved health care for all patients. The hybrid option allows POC the potential to deliver the best possible care available to all patients, every time.
