June 2017
Volume 58, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2017
Lean evaluation of glaucoma clinic wait times to inform the development of an educational intervention
Author Affiliations & Notes
  • Nish Patel
    University of Michigan, Ann Arbor, Michigan, United States
  • Casey Scavone
    University of Michigan, Ann Arbor, Michigan, United States
  • John Musser
    University of Michigan, Ann Arbor, Michigan, United States
  • Leslie Niziol
    University of Michigan, Ann Arbor, Michigan, United States
  • Abhilash Rao
    University of Michigan, Ann Arbor, Michigan, United States
  • Elizabeth Olin
    University of Michigan, Ann Arbor, Michigan, United States
  • Amy Cohn
    University of Michigan, Ann Arbor, Michigan, United States
  • Shivani Kamat
    University of Michigan, Ann Arbor, Michigan, United States
  • Manjool Shah
    University of Michigan, Ann Arbor, Michigan, United States
  • Paula Anne Newman-Casey
    University of Michigan, Ann Arbor, Michigan, United States
  • Footnotes
    Commercial Relationships   Nish Patel, None; Casey Scavone, None; John Musser, None; Leslie Niziol, None; Abhilash Rao, None; Elizabeth Olin, None; Amy Cohn, None; Shivani Kamat, None; Manjool Shah, None; Paula Anne Newman-Casey, Blue Health Intelligence (C)
  • Footnotes
    Support   National Eye Institute 1K23EY025320, Research to Prevent Blindness
Investigative Ophthalmology & Visual Science June 2017, Vol.58, 5048. doi:
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    • Get Citation

      Nish Patel, Casey Scavone, John Musser, Leslie Niziol, Abhilash Rao, Elizabeth Olin, Amy Cohn, Shivani Kamat, Manjool Shah, Paula Anne Newman-Casey; Lean evaluation of glaucoma clinic wait times to inform the development of an educational intervention. Invest. Ophthalmol. Vis. Sci. 2017;58(8):5048.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : Adherence to medications proven to decrease glaucomatous progression is poor at about 50%. Personalized educational interventions have been successful in improving adherence, but these interventions are time-intensive. Contrary to provider views of a lack of time for more education in clinic, many glaucoma patients complain about long wait times. We conducted a prospective, observational study utilizing Lean analysis of glaucoma clinic flow to identify and quantify wait times during a patient visit that might be used for education.

Methods : A convenience sample of new visit (NV) and return visit (RV) patients seen at the Kellogg Eye Center glaucoma clinic was obtained over 2 months, across different providers and weekdays. Patients were followed through their clinic visit and length of time spent within each component of their visit was recorded. Lean analysis was performed including value stream mapping and root cause analysis.

Results : 64 patients were studied, including 16 NV (25%) and 48 RV patients (75%). The visit process included steps for reception (check-in and out), evaluations by technicians, residents, and attending physicians, ancillary testing, and wait times between steps (Figure). Visits were on average 2.8 hours (standard deviation, SD=0.5) for NV patients and 1.7 hours (SD=0.7) for RV patients. Average wait time was similar between visit types (NV=53.4 minutes, SD=14.6; RV=52.6 minutes, SD=31.6). The percent of wait time to total visit time was significantly larger on average for RV patients (49.4%) compared to NV patients (32.0%; p<0.0001, 2-sample t-test). The percent of subjects with at least one 5, 10, 15, 20, and 30+ minute wait time during their visit was 100%, 100%, 81%, 25%, and 6%, for NV patients and 100%, 88%, 69%, 58%, and 33% for RV patients, respectively. The longest portions of wait time corresponded to the reception wait time after check-in and time in the clinic room waiting for the attending physician. The root causes of wait times identified were scheduling, batching of patients, and process variability among providers.

Conclusions : Educational interventions that can be delivered in 10-15 minute blocks may be best integrated into clinic flow. Clinic efficiency should be improved to decrease five-minute wait times as they are unlikely to be useful for education.

This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.

 

Clinic visit process

Clinic visit process

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