IDEAS home Printed from https://ideas.repec.org/a/sae/medema/v35y2015i6p745-757.html
   My bibliography  Save this article

Impact of Diabetes E-Consults on Outpatient Clinic Workflow

Author

Listed:
  • Brian Zoll
  • Pratik J. Parikh
  • Jennie Gallimore
  • Stephen Harrell
  • Brian Burke

Abstract

Background. An e-consult is an electronic communication system between clinicians, usually a primary care physician (PCP) and a medical or surgical specialist, regarding general or patient-specific, low complexity questions that would not need an in-person consultation. The objectives of this study were to understand and quantify the impact of the e-consult initiative on outpatient clinic workflow and outcomes. Methods. We collected data from 5 different Veterans Affairs (VA) outpatient clinics and interviewed several physicians and staff members. We then developed a simulation model for a primary care team at an outpatient clinic. A detailed experimental study was conducted to determine the effects of factors, such as e-consult demand, view-alert notification arrivals, walk-in patient arrivals, and PCP unavailability, on e-consult cycle time. Results. Statistical tests indicated that 4 factors related to outpatient clinic workflow were significant, and levels within each of the 4 significant factors resulted in statistically different e-consult cycle times. The arrival rate of electronic notifications, along with patient walk-ins, had a considerable effect on cycle time. Splitting the workload of an unavailable PCP among the other PCPs, instead of the current practice of allocating it to a single PCP, increases the system’s ability to handle a much larger e-consult demand. Conclusions. The full potential of e-consults can only be realized if the workflow at the outpatient clinics is designed or modified to support this initiative. This study furthers our understanding of how e-consult systems can be analyzed and alternative workflows tested using statistical and simulation modeling to improve care delivery and outcomes.

Suggested Citation

  • Brian Zoll & Pratik J. Parikh & Jennie Gallimore & Stephen Harrell & Brian Burke, 2015. "Impact of Diabetes E-Consults on Outpatient Clinic Workflow," Medical Decision Making, , vol. 35(6), pages 745-757, August.
    • Handle: RePEc:sae:medema:v:35:y:2015:i:6:p:745-757
    DOI: 10.1177/0272989X14556511
    as

    Download full text from publisher

    File URL: https://journals.sagepub.com/doi/10.1177/0272989X14556511
    Download Restriction: no
    File URL: https://libkey.io/10.1177/0272989X14556511?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    References listed on IDEAS

    as
    1. Pablo Santibáñez & Vincent Chow & John French & Martin Puterman & Scott Tyldesley, 2009. "Reducing patient wait times and improving resource utilization at British Columbia Cancer Agency’s ambulatory care unit through simulation," Health Care Management Science, Springer, vol. 12(4), pages 392-407, December.
    2. Suresh Chand & Herbert Moskowitz & John Norris & Steve Shade & Deanna Willis, 2009. "Improving patient flow at an outpatient clinic: study of sources of variability and improvement factors," Health Care Management Science, Springer, vol. 12(3), pages 325-340, September.
    3. Thomas Rohleder & Peter Lewkonia & Diane Bischak & Paul Duffy & Rosa Hendijani, 2011. "Using simulation modeling to improve patient flow at an outpatient orthopedic clinic," Health Care Management Science, Springer, vol. 14(2), pages 135-145, June.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Mielczarek, Bożena, 2014. "Simulation modelling for contracting hospital emergency services at the regional level," European Journal of Operational Research, Elsevier, vol. 235(1), pages 287-299.
    2. Tugba Cayirli & Kum Khiong Yang, 2019. "Altering the Environment to Improve Appointment System Performance," Service Science, INFORMS, vol. 11(2), pages 138-154, June.
    3. Baril, Chantal & Gascon, Viviane & Miller, Jonathan & Côté, Nadine, 2016. "Use of a discrete-event simulation in a Kaizen event: A case study in healthcare," European Journal of Operational Research, Elsevier, vol. 249(1), pages 327-339.
    4. Chong Pan & Dali Zhang & Audrey Kon & Charity Wai & Woo Ang, 2015. "Patient flow improvement for an ophthalmic specialist outpatient clinic with aid of discrete event simulation and design of experiment," Health Care Management Science, Springer, vol. 18(2), pages 137-155, June.
    5. Xiuli Qu & Yidong Peng & Nan Kong & Jing Shi, 2013. "A two-phase approach to scheduling multi-category outpatient appointments – A case study of a women’s clinic," Health Care Management Science, Springer, vol. 16(3), pages 197-216, September.
    6. P. Troy & N. Lahrichi & D. Porubska & L. Rosenberg, 2020. "Fine-grained simulation optimization for the design and operations of a multi-activity clinic," Flexible Services and Manufacturing Journal, Springer, vol. 32(3), pages 599-628, September.
    7. Eren Demir & David Southern, 2017. "Enabling better management of patients: discrete event simulation combined with the STAR approach," Journal of the Operational Research Society, Palgrave Macmillan;The OR Society, vol. 68(5), pages 577-590, May.
    8. Ward, Michael J. & Marsolo, Keith A. & Froehle, Craig M., 2014. "Applications of business analytics in healthcare," Business Horizons, Elsevier, vol. 57(5), pages 571-582.
    9. Willoughby, Keith A. & Chan, Benjamin T.B. & Marques, Shauna, 2016. "Using simulation to test ideas for improving speech language pathology services," European Journal of Operational Research, Elsevier, vol. 252(2), pages 657-664.
    10. Shehadeh, Karmel S. & Cohn, Amy E.M. & Jiang, Ruiwei, 2020. "A distributionally robust optimization approach for outpatient colonoscopy scheduling," European Journal of Operational Research, Elsevier, vol. 283(2), pages 549-561.
    11. Agnetis, Alessandro & Bianciardi, Caterina & Iasparra, Nicola, 2019. "Integrating lean thinking and mathematical optimization: A case study in appointment scheduling of hematological treatments," Operations Research Perspectives, Elsevier, vol. 6(C).
    12. Dimitrios Stathopoulos & Eva Ekvall Hansson & Kjerstin Stigmar, 2021. "Exploring the Environment behind In-Patient Falls and Their Relation to Hospital Overcrowdedness—A Register-Based Observational Study," IJERPH, MDPI, vol. 18(20), pages 1-10, October.
    13. Qu, Xiuli & Peng, Yidong & Shi, Jing & LaGanga, Linda, 2015. "An MDP model for walk-in patient admission management in primary care clinics," International Journal of Production Economics, Elsevier, vol. 168(C), pages 303-320.
    14. Ahmadi-Javid, Amir & Jalali, Zahra & Klassen, Kenneth J, 2017. "Outpatient appointment systems in healthcare: A review of optimization studies," European Journal of Operational Research, Elsevier, vol. 258(1), pages 3-34.
    15. Chang Wook Kang & Muhammad Imran & Muhammad Omair & Waqas Ahmed & Misbah Ullah & Biswajit Sarkar, 2019. "Stochastic-Petri Net Modeling and Optimization for Outdoor Patients in Building Sustainable Healthcare System Considering Staff Absenteeism," Mathematics, MDPI, vol. 7(6), pages 1-26, June.
    16. Vahab Vahdat & Jacqueline Griffin & James E. Stahl, 2018. "Decreasing patient length of stay via new flexible exam room allocation policies in ambulatory care clinics," Health Care Management Science, Springer, vol. 21(4), pages 492-516, December.
    17. Samuel Davis & Nasser Fard, 2020. "Theoretical bounds and approximation of the probability mass function of future hospital bed demand," Health Care Management Science, Springer, vol. 23(1), pages 20-33, March.
    18. Proudlove, N.C. & Bisogno, S. & Onggo, B.S.S. & Calabrese, A. & Levialdi Ghiron, N., 2017. "Towards fully-facilitated discrete event simulation modelling: Addressing the model coding stage," European Journal of Operational Research, Elsevier, vol. 263(2), pages 583-595.
    19. Xiang Zhong & Hyo Kyung Lee & Molly Williams & Sally Kraft & Jeffery Sleeth & Richard Welnick & Lori Hauschild & Jingshan Li, 2018. "Workload balancing: staffing ratio analysis for primary care redesign," Flexible Services and Manufacturing Journal, Springer, vol. 30(1), pages 6-29, June.
    20. Jaime González & Juan-Carlos Ferrer & Alejandro Cataldo & Luis Rojas, 2019. "A proactive transfer policy for critical patient flow management," Health Care Management Science, Springer, vol. 22(2), pages 287-303, June.

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:sae:medema:v:35:y:2015:i:6:p:745-757. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: SAGE Publications (email available below). General contact details of provider: .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.