Limited waiting areas in outpatient clinics: an intervention to incorporate the effect of bridging times in blueprint schedules
Dijkstra, Sander; Otten, Maarten; Leeftink, Gréanne; Kamphorst, Bas; Olde Meierink, Angelique; Heinen, Anouk; Bijlsma, Rhodé; Boucherie, Richard J
(2022) BMJ Open Quality, volume 11, issue 2
(Article)
Abstract
BACKGROUND: Distancing measures enforced by the COVID-19 pandemic impose a restriction on the number of patients simultaneously present in hospital waiting areas. OBJECTIVE: Evaluate waiting area occupancy of an intervention that designs clinic blueprint schedules, in which all appointments of the pre-COVID-19 case mix are scheduled either digitally or in
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person under COVID-19 distancing measures, whereby the number of in-person appointments is maximised. METHODS: Preintervention analysis and prospective assessment of intervention outcomes were used to evaluate the outcomes on waiting area occupancy and number of in-person consultations (postintervention only) using descriptive statistics, for two settings in the Rheumatology Clinic of Sint Maartenskliniek (SMK) and Medical Oncology & Haematology Outpatient Clinic of University Medical Center Utrecht (UMCU). Retrospective data from October 2019 to February 2020 were used to evaluate the pre-COVID-19 blueprint schedules. An iterative optimisation and simulation approach was followed, based on integer linear programming and Monte Carlo simulation, which iteratively optimised and evaluated blueprint schedules until the 95% CI of the number of patients in the waiting area did not exceed available capacity. RESULTS: Under pre-COVID-19 blueprint schedules, waiting areas would be overcrowded by up to 22 (SMK) and 11 (UMCU) patients, given the COVID-19 distancing measures. The postintervention blueprint scheduled all appointments without overcrowding the waiting areas, of which 88% and 87% were in person and 12% and 13% were digitally (SMK and UMCU, respectively). CONCLUSIONS: The intervention was effective in two case studies with different waiting area characteristics and a varying number of interdependent patient trajectory stages. The intervention is generically applicable to a wide range of healthcare services that schedule a (series of) appointment(s) for their patients. Care providers can use the intervention to evaluate overcrowding of waiting area(s) and design optimal blueprint schedules to continue a maximum number of in-person appointments under pandemic distancing measures.
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Keywords: Ambulatory Care Facilities, COVID-19/prevention & control, Humans, Pandemics/prevention & control, Prospective Studies, Retrospective Studies, COVID-19, Outpatients, Simulation, Decision support, computerised, Efficiency, Organizational, Public Health, Environmental and Occupational Health, Health Policy, Leadership and Management, Research Support, Non-U.S. Gov't, Journal Article
ISSN: 2399-6641
Publisher: BMJ Publishing Group
Note: Funding Information: This project was partly financed by the Netherlands Organisation for Health Research and Development (ZonMw) under grant number 10430042010015. Publisher Copyright: © 2022 BMJ Publishing Group. All rights reserved.
(Peer reviewed)