Designing patient throughput and task management innovations in orthopaedics

The Orthopaedic and Sports Medicine Clinics of the University of Virginia Health System are collocated in the Fontaine Research Park. The two departments operate in separate clinics, but share a Radiology Department. Collectively, the clinics serve about 42,000 outpatient visits annually. With patient visits projected to increase substantially in the coming years, the clinics seek process improvements that will accommodate growth and sustain strong patient satisfaction well into the future. This paper describes a simulation study of patient flows in the clinics under various future demand scenarios, including alternative patient volumes and no-show rates. The study explored the impact of best practices for in-clinic task management, patient and staff scheduling, and patient communications. Key performance measures included patient waiting times, total time in clinic, facility utilization, and on-time clinic closings. The model was developed based on patient schedule and tracking data. The results of the simulation model and clinic observations provided evidence to support multiple process improvements within the clinics. Introducing an additional front desk attendant in each clinic during busy times to assist with incoming phone calls and patient check-ins will allow for patients to be seen sooner and for more efficient appointment scheduling. Altering appointment time slots from 15 minutes to 10 minutes and distributing scheduled appointments more evenly throughout the day will allow providers to see more patients and reduce the need for overbooking, effectively decreasing patient waiting time. Based on the results of our analysis, implementing these changes to the clinics may allow for future growth while preserving patient satisfaction.