Improving Patient Wait Times for OncologyImproving Patient Wait Times for Oncology Team 29 VA...
Transcript of Improving Patient Wait Times for OncologyImproving Patient Wait Times for Oncology Team 29 VA...
![Page 1: Improving Patient Wait Times for OncologyImproving Patient Wait Times for Oncology Team 29 VA Process Sana Fathima, Courtney Hall, Ousmane Kaba, Gun Hee Lee, Zeba Munshi, Christopher](https://reader030.fdocuments.net/reader030/viewer/2022040819/5e6677e61e6e765f5d6c3deb/html5/thumbnails/1.jpg)
Improving Patient Wait Times for Oncology
Team 29 VA Process
Sana Fathima, Courtney Hall, Ousmane Kaba, Gun Hee Lee, Zeba Munshi, Christopher Noerjadi,
Rebeccah Sharpe, Mario Wijaya
Client Contact: LaGaunda JonesFaculty Advisor: Dr. Julie Swann
Atlanta VA Medical Center
April 10th, 2017
*Disclaimer: This project has been created as a part of a student design project at the Georgia Institute of Technology.
![Page 2: Improving Patient Wait Times for OncologyImproving Patient Wait Times for Oncology Team 29 VA Process Sana Fathima, Courtney Hall, Ousmane Kaba, Gun Hee Lee, Zeba Munshi, Christopher](https://reader030.fdocuments.net/reader030/viewer/2022040819/5e6677e61e6e765f5d6c3deb/html5/thumbnails/2.jpg)
Executive Summary
Problem
Time spent from Check-in to Treatment Chair: 99 minutes
Target time: 45 minutes
Additional Opportunity:
Expansion
Lab Understaffing Physician Constraints Treatment Scheduling
Community Based
Outpatient ClinicScenarios Scheduling Tool
Final Solution
Nurse
Overtime
2
![Page 3: Improving Patient Wait Times for OncologyImproving Patient Wait Times for Oncology Team 29 VA Process Sana Fathima, Courtney Hall, Ousmane Kaba, Gun Hee Lee, Zeba Munshi, Christopher](https://reader030.fdocuments.net/reader030/viewer/2022040819/5e6677e61e6e765f5d6c3deb/html5/thumbnails/3.jpg)
● Provides health care services to veterans● From general check-ups to surgeries● More than 130,000 enrolled Veterans
● 40 - 60 patients per day● Recurring appointments ● 35 types of treatment ● Treatment duration range varies● Oncology Treatment Center resources:
○ 6-7 nurses
○ 15 Chairs & 3 Beds
Client Background
3
Veterans Affairs Medical Center (VAMC)
The Oncology Department
![Page 4: Improving Patient Wait Times for OncologyImproving Patient Wait Times for Oncology Team 29 VA Process Sana Fathima, Courtney Hall, Ousmane Kaba, Gun Hee Lee, Zeba Munshi, Christopher](https://reader030.fdocuments.net/reader030/viewer/2022040819/5e6677e61e6e765f5d6c3deb/html5/thumbnails/4.jpg)
System Description
4*See Appendix Pages 22 for distributions.
Patient TypePercentage of
patient type
Total time from Front
Desk to Physician or
Treatment
Physician Only 26% 70 minutes
Treatment Only 52% 99 minutes
Both 22% 146 minutes
![Page 5: Improving Patient Wait Times for OncologyImproving Patient Wait Times for Oncology Team 29 VA Process Sana Fathima, Courtney Hall, Ousmane Kaba, Gun Hee Lee, Zeba Munshi, Christopher](https://reader030.fdocuments.net/reader030/viewer/2022040819/5e6677e61e6e765f5d6c3deb/html5/thumbnails/5.jpg)
System Description
5*See Appendix Page 22 for distribution.
Patient TypePercentage of
patient type
Total time from Front
Desk to Physician or
Treatment
Physician Only 26% 70 minutes
Treatment Only 52% 99 minutes
Both 22% 146 minutes
![Page 6: Improving Patient Wait Times for OncologyImproving Patient Wait Times for Oncology Team 29 VA Process Sana Fathima, Courtney Hall, Ousmane Kaba, Gun Hee Lee, Zeba Munshi, Christopher](https://reader030.fdocuments.net/reader030/viewer/2022040819/5e6677e61e6e765f5d6c3deb/html5/thumbnails/6.jpg)
System Description
6*See Appendix Page 22 for distribution.
Patient TypePercentage of
patient type
Total time from Front
Desk to Physician or
Treatment
Physician Only 26% 70 minutes
Treatment Only 52% 99 minutes
Both 22% 146 minutes
![Page 7: Improving Patient Wait Times for OncologyImproving Patient Wait Times for Oncology Team 29 VA Process Sana Fathima, Courtney Hall, Ousmane Kaba, Gun Hee Lee, Zeba Munshi, Christopher](https://reader030.fdocuments.net/reader030/viewer/2022040819/5e6677e61e6e765f5d6c3deb/html5/thumbnails/7.jpg)
● Data Collection:
○ VistA (Veterans Information System and Technology Architecture)
○ CPRS (Computerized Patient Record System)
○ Time study observations
○ Nurse assignment sheet
● Scenario testing using validated simulation model
Methodology
Problem
7
● Best usage of space○ Number of beds vs chairs
Expansion
● Reduce time spent from Front Desk to Treatment to target time:
○ Treatment only: 45 minutes○ Physician and treatment: 1 hour and
15 minutes
Treatment Center
![Page 8: Improving Patient Wait Times for OncologyImproving Patient Wait Times for Oncology Team 29 VA Process Sana Fathima, Courtney Hall, Ousmane Kaba, Gun Hee Lee, Zeba Munshi, Christopher](https://reader030.fdocuments.net/reader030/viewer/2022040819/5e6677e61e6e765f5d6c3deb/html5/thumbnails/8.jpg)
Problem - Lab
8
*For breakdown by day, see Appendix Page 35
● Time until lab results released○ Average time: 1 hour and 23 minutes○ Standard Deviation: 36 minutes
● Wait time for lab check-in○ Average time: 40 minutes○ Standard Deviation: 10 minutes
● Over 60% of oncology patients delayed
Long Wait Times
![Page 9: Improving Patient Wait Times for OncologyImproving Patient Wait Times for Oncology Team 29 VA Process Sana Fathima, Courtney Hall, Ousmane Kaba, Gun Hee Lee, Zeba Munshi, Christopher](https://reader030.fdocuments.net/reader030/viewer/2022040819/5e6677e61e6e765f5d6c3deb/html5/thumbnails/9.jpg)
Problem - Lab
9
*For breakdown by day, see Appendix Page 35
● Time until lab results released○ Average time: 1 hour and 23 minutes○ Standard Deviation: 36 minutes
● Wait time for lab check-in○ Average time: 40 minutes○ Standard Deviation: 10 minutes
● Over 60% of oncology patients delayed
Long Wait Times
![Page 10: Improving Patient Wait Times for OncologyImproving Patient Wait Times for Oncology Team 29 VA Process Sana Fathima, Courtney Hall, Ousmane Kaba, Gun Hee Lee, Zeba Munshi, Christopher](https://reader030.fdocuments.net/reader030/viewer/2022040819/5e6677e61e6e765f5d6c3deb/html5/thumbnails/10.jpg)
Problem - Lab
10
● CBOC: Community Based Outpatient Clinics○ Lab work, non-specialized treatment○ 13 locations feed to Atlanta VAMC
● Up to 80 % of patients can go to CBOC● Hire more phlebotomists due to long wait times and
process times
Solutions*For breakdown by day, see Appendix Page 35
● Time until lab results released○ Average time: 1 hour and 23 minutes○ Standard Deviation: 36 minutes
● Wait time for lab check-in○ Average time: 40 minutes○ Standard Deviation: 10 minutes
● Over 60% of oncology patients delayed
Long Wait Times
![Page 11: Improving Patient Wait Times for OncologyImproving Patient Wait Times for Oncology Team 29 VA Process Sana Fathima, Courtney Hall, Ousmane Kaba, Gun Hee Lee, Zeba Munshi, Christopher](https://reader030.fdocuments.net/reader030/viewer/2022040819/5e6677e61e6e765f5d6c3deb/html5/thumbnails/11.jpg)
● No full time physician for Oncology ● Room availability issue● Each physician has different appointment
lengths○ From 15 minutes to 1 hour
11
● Assigning treatment time and type● Unable to see oncology schedule● Great variability in number of patients into
treatment center on a daily basis
Current Process
Problem - Physician Constraints
● Better visibility of treatment grid ● Balancing oncology appointments with physician
visits
Solutions
Current State
Physician appointment availability
![Page 12: Improving Patient Wait Times for OncologyImproving Patient Wait Times for Oncology Team 29 VA Process Sana Fathima, Courtney Hall, Ousmane Kaba, Gun Hee Lee, Zeba Munshi, Christopher](https://reader030.fdocuments.net/reader030/viewer/2022040819/5e6677e61e6e765f5d6c3deb/html5/thumbnails/12.jpg)
12
● Treatment Scheduling Procedure
○ Appointments scheduled between
7:30 am - 3:00 pm
○ Physicians request appointment
○ Schedulers place appointment
■ Overbooking Policy
● Current Scheduling Grid
Scheduling
10 Patients “Overbooked”
Problem - Treatment
● Provide Excel tool to help schedule patients
● Change from 1 grid to 6 grids
● Nurses will do return to clinic orders
● Create better communication with nurses
and physicians
Solutions
VistA Grid
No One Scheduled
3 Patients Scheduled
![Page 13: Improving Patient Wait Times for OncologyImproving Patient Wait Times for Oncology Team 29 VA Process Sana Fathima, Courtney Hall, Ousmane Kaba, Gun Hee Lee, Zeba Munshi, Christopher](https://reader030.fdocuments.net/reader030/viewer/2022040819/5e6677e61e6e765f5d6c3deb/html5/thumbnails/13.jpg)
Problem - Nurse Overtime
13
● Charge nurse comes in early to assign patient and
handles late patients
● Analysis:
○ Total of 1830 hours of overtime
○ 4 nurses worked 77% of total overtime hours
Nurse Overtime
*For cost comparison, see Appendix Page 49
![Page 14: Improving Patient Wait Times for OncologyImproving Patient Wait Times for Oncology Team 29 VA Process Sana Fathima, Courtney Hall, Ousmane Kaba, Gun Hee Lee, Zeba Munshi, Christopher](https://reader030.fdocuments.net/reader030/viewer/2022040819/5e6677e61e6e765f5d6c3deb/html5/thumbnails/14.jpg)
Problem - Nurse Overtime
14
● Charge nurse comes in early to assign patient and
handles late patients
● Analysis:
○ Total of 1830 hours of overtime
○ 4 nurses worked 77% of total overtime hours
Nurse Overtime
*For cost comparison, see Appendix Page 49
![Page 15: Improving Patient Wait Times for OncologyImproving Patient Wait Times for Oncology Team 29 VA Process Sana Fathima, Courtney Hall, Ousmane Kaba, Gun Hee Lee, Zeba Munshi, Christopher](https://reader030.fdocuments.net/reader030/viewer/2022040819/5e6677e61e6e765f5d6c3deb/html5/thumbnails/15.jpg)
Problem - Nurse Overtime
15
● Charge nurse comes in early to assign patient and
handles late patients
● Analysis:
○ Total of 1830 hours of overtime
○ 4 nurses worked 77% of total overtime hours
Nurse Overtime
*For cost comparison, see Appendix Page 49
![Page 16: Improving Patient Wait Times for OncologyImproving Patient Wait Times for Oncology Team 29 VA Process Sana Fathima, Courtney Hall, Ousmane Kaba, Gun Hee Lee, Zeba Munshi, Christopher](https://reader030.fdocuments.net/reader030/viewer/2022040819/5e6677e61e6e765f5d6c3deb/html5/thumbnails/16.jpg)
Problem - Nurse Overtime
16
● Charge nurse comes in early to assign patient and
handles late patients
● Analysis:
○ Total of 1830 hours of overtime
○ 4 nurses worked 77% of total overtime hours
Nurse Overtime
● Due to hiring freeze:
○ Re-allocating available treatment nurses to
assist
○ Scheduling Scenarios/Tool
Solutions
*For cost comparison, see Appendix Page 49
![Page 17: Improving Patient Wait Times for OncologyImproving Patient Wait Times for Oncology Team 29 VA Process Sana Fathima, Courtney Hall, Ousmane Kaba, Gun Hee Lee, Zeba Munshi, Christopher](https://reader030.fdocuments.net/reader030/viewer/2022040819/5e6677e61e6e765f5d6c3deb/html5/thumbnails/17.jpg)
Deliverables
17
&● Scheduling guidelines● CBOC percentage● New VistA grid design● Scheduling tool and
documentation
Treatment Center
● Scheduling guidelines● CBOC percentage● Layout within the federal
guidelines
Expansion
![Page 18: Improving Patient Wait Times for OncologyImproving Patient Wait Times for Oncology Team 29 VA Process Sana Fathima, Courtney Hall, Ousmane Kaba, Gun Hee Lee, Zeba Munshi, Christopher](https://reader030.fdocuments.net/reader030/viewer/2022040819/5e6677e61e6e765f5d6c3deb/html5/thumbnails/18.jpg)
Simulation - Validation
18
Beta Distribution Mean: 234 minsSD: 129 mins
Front Desk to out of Oncology Treatment Center
Beta DistributionMean: 232 minsSD: 97 mins
Kolmogorov-Smirnov Test:Test Statistic: 0.0223Failed to reject Null HypothesisAnderson-Darling Test:Test Statistic: 0.36276Failed to reject Null Hypothesis
Simulation Output
*Refer to appendix pages 25-28 for all other days and appendix page 34-35 for simulation inputs and distributions
Inputs● Patient arrivals● Resources for each
process● Process times
Outputs● Time in the system● Waiting times
![Page 19: Improving Patient Wait Times for OncologyImproving Patient Wait Times for Oncology Team 29 VA Process Sana Fathima, Courtney Hall, Ousmane Kaba, Gun Hee Lee, Zeba Munshi, Christopher](https://reader030.fdocuments.net/reader030/viewer/2022040819/5e6677e61e6e765f5d6c3deb/html5/thumbnails/19.jpg)
19
Exam Room 1 Exam Room 2 Exam Room 3
Recovery Rooms
![Page 20: Improving Patient Wait Times for OncologyImproving Patient Wait Times for Oncology Team 29 VA Process Sana Fathima, Courtney Hall, Ousmane Kaba, Gun Hee Lee, Zeba Munshi, Christopher](https://reader030.fdocuments.net/reader030/viewer/2022040819/5e6677e61e6e765f5d6c3deb/html5/thumbnails/20.jpg)
20
Simulation - Treatment Scenario
Short (3 - 22 minutes) Short
Short Medium (22 - 85 minutes)
Medium (85 - 130 minutes)
Medium Long (130 - 205 minutes)
Long (More than 205 minutes)
Best treatment scheduling scenario from simulation
![Page 21: Improving Patient Wait Times for OncologyImproving Patient Wait Times for Oncology Team 29 VA Process Sana Fathima, Courtney Hall, Ousmane Kaba, Gun Hee Lee, Zeba Munshi, Christopher](https://reader030.fdocuments.net/reader030/viewer/2022040819/5e6677e61e6e765f5d6c3deb/html5/thumbnails/21.jpg)
Scheduling Tool
21Created using Excel VBA
![Page 22: Improving Patient Wait Times for OncologyImproving Patient Wait Times for Oncology Team 29 VA Process Sana Fathima, Courtney Hall, Ousmane Kaba, Gun Hee Lee, Zeba Munshi, Christopher](https://reader030.fdocuments.net/reader030/viewer/2022040819/5e6677e61e6e765f5d6c3deb/html5/thumbnails/22.jpg)
Scheduling Tool
22Created using Excel VBA
![Page 23: Improving Patient Wait Times for OncologyImproving Patient Wait Times for Oncology Team 29 VA Process Sana Fathima, Courtney Hall, Ousmane Kaba, Gun Hee Lee, Zeba Munshi, Christopher](https://reader030.fdocuments.net/reader030/viewer/2022040819/5e6677e61e6e765f5d6c3deb/html5/thumbnails/23.jpg)
Scheduling Tool
23Created using Excel VBA
![Page 24: Improving Patient Wait Times for OncologyImproving Patient Wait Times for Oncology Team 29 VA Process Sana Fathima, Courtney Hall, Ousmane Kaba, Gun Hee Lee, Zeba Munshi, Christopher](https://reader030.fdocuments.net/reader030/viewer/2022040819/5e6677e61e6e765f5d6c3deb/html5/thumbnails/24.jpg)
Scheduling Tool
24Created using Excel VBA
![Page 25: Improving Patient Wait Times for OncologyImproving Patient Wait Times for Oncology Team 29 VA Process Sana Fathima, Courtney Hall, Ousmane Kaba, Gun Hee Lee, Zeba Munshi, Christopher](https://reader030.fdocuments.net/reader030/viewer/2022040819/5e6677e61e6e765f5d6c3deb/html5/thumbnails/25.jpg)
Scheduling Tool
25Created using Excel VBA
![Page 26: Improving Patient Wait Times for OncologyImproving Patient Wait Times for Oncology Team 29 VA Process Sana Fathima, Courtney Hall, Ousmane Kaba, Gun Hee Lee, Zeba Munshi, Christopher](https://reader030.fdocuments.net/reader030/viewer/2022040819/5e6677e61e6e765f5d6c3deb/html5/thumbnails/26.jpg)
26
Scheduling Tool
![Page 27: Improving Patient Wait Times for OncologyImproving Patient Wait Times for Oncology Team 29 VA Process Sana Fathima, Courtney Hall, Ousmane Kaba, Gun Hee Lee, Zeba Munshi, Christopher](https://reader030.fdocuments.net/reader030/viewer/2022040819/5e6677e61e6e765f5d6c3deb/html5/thumbnails/27.jpg)
Scheduling Tool - Grid Design
● 6 scheduling grids representing 6 nurses
● Each half hour has [3] for 3 chairs
○ 1:3 nurse to chair ratio● 1 nurse trained with
scheduling tool ● Implement guidelines
Phase 1: 6 grids
27
“This tool will reduce my time scheduling patients each morning”“It is a very useful tool, that will help keep our 6 grids straight”
![Page 28: Improving Patient Wait Times for OncologyImproving Patient Wait Times for Oncology Team 29 VA Process Sana Fathima, Courtney Hall, Ousmane Kaba, Gun Hee Lee, Zeba Munshi, Christopher](https://reader030.fdocuments.net/reader030/viewer/2022040819/5e6677e61e6e765f5d6c3deb/html5/thumbnails/28.jpg)
Scheduling Tool - Grid Design
● 6 scheduling grids representing 6 nurses
● Each half hour has [3] for 3 chairs
○ 1:3 nurse to chair ratio● 1 nurse trained with
scheduling tool ● Implement guidelines
Phase 1: 6 grids
● Transition to 18 grids○ 1 grid per chair
● Each half hour has [1] for 1 patient
● Train all nurses to use scheduling tool
Phase 2: 18 Grids
28
VistA Grid for Chair 1
“This tool will reduce my time scheduling patients each morning”“It is a very useful tool, that will help keep our 6 grids straight”
No One Scheduled
1 Patient Scheduled
![Page 29: Improving Patient Wait Times for OncologyImproving Patient Wait Times for Oncology Team 29 VA Process Sana Fathima, Courtney Hall, Ousmane Kaba, Gun Hee Lee, Zeba Munshi, Christopher](https://reader030.fdocuments.net/reader030/viewer/2022040819/5e6677e61e6e765f5d6c3deb/html5/thumbnails/29.jpg)
● 2 beds, 2 chairs in exam room 1
● Convert room 2 into physician exam room
● Convert room 3 into physician exam room
● 1 chair per recovery room (6 total)
Alternative 3: Hybrid
Exam Room 3Exam Room 2Exam Room 1
Expansion Options
29
1 2 3 4 5 6
● 1 bed per exam room (3 total)
● 1 chair per recovery room (6 total)
Alternative 1: Cost Conservative
● 2 beds, 2 chairs in exam room 1
● 4 chairs in exam Room 2
● 2 chairs in exam Room 3
● 1 chair per recovery room (6 total)
Alternative 2: Maximum
● 2 beds, 2 chairs in exam room 1
● 4 chairs in exam room 2
● 2 chairs in exam room 3
● 1 chair per recovery room (6 total)
Alternative 2: Maximum Resources
![Page 30: Improving Patient Wait Times for OncologyImproving Patient Wait Times for Oncology Team 29 VA Process Sana Fathima, Courtney Hall, Ousmane Kaba, Gun Hee Lee, Zeba Munshi, Christopher](https://reader030.fdocuments.net/reader030/viewer/2022040819/5e6677e61e6e765f5d6c3deb/html5/thumbnails/30.jpg)
● 2 beds, 2 chairs in exam room 1
● 4 chairs in exam room 2
● 2 chairs in exam room 3
● 1 chair per recovery room (6 total)
Alternative 2: Maximum Resources
● 1 bed per exam room (3 total)
● 1 chair per recovery room (6 total)
Exam Room 3Exam Room 2Exam Room 1
Expansion Options
30
1 2 3 4 5 6
● 2 beds, 2 chairs in exam room 1
● Convert room 2 into physician exam room
● Convert room 3 into physician exam room
● 1 chair per recovery room (6 total)
Alternative 3: Hybrid
Alternative 1: Cost Conservative
![Page 31: Improving Patient Wait Times for OncologyImproving Patient Wait Times for Oncology Team 29 VA Process Sana Fathima, Courtney Hall, Ousmane Kaba, Gun Hee Lee, Zeba Munshi, Christopher](https://reader030.fdocuments.net/reader030/viewer/2022040819/5e6677e61e6e765f5d6c3deb/html5/thumbnails/31.jpg)
Exam Room 3Exam Room 2Exam Room 1
Expansion Options
31
1 2 3 4 5 6
● 2 beds, 2 chairs in exam room 1
● Convert room 2 into physician exam room
● Convert room 3 into physician exam room
● 1 chair per recovery room (6 total)
Alternative 3: Hybrid
● 1 bed per exam room (3 total)
● 1 chair per recovery room (6 total)
Alternative 1: Cost Conservative
● 2 beds, 2 chairs in exam room 1
● 4 chairs in exam room 2
● 2 chairs in exam room 3
● 1 chair per recovery room (6 total)
Alternative 2: Maximum Resources
![Page 32: Improving Patient Wait Times for OncologyImproving Patient Wait Times for Oncology Team 29 VA Process Sana Fathima, Courtney Hall, Ousmane Kaba, Gun Hee Lee, Zeba Munshi, Christopher](https://reader030.fdocuments.net/reader030/viewer/2022040819/5e6677e61e6e765f5d6c3deb/html5/thumbnails/32.jpg)
Exam Room 3Exam Room 2Exam Room 1
Expansion Options
32
1 2 3 4 5 6
● 2 beds, 2 chairs in exam room 1
● Convert room 2 into physician exam room
● Convert room 3 into physician exam room
● 1 chair per recovery room (6 total)
SOLUTION
● 1 bed per exam room (3 total)
● 1 chair per recovery room (6 total)
Alternative 1: Cost Conservative
● 2 beds, 2 chairs in exam room 1
● 4 chairs in exam room 2
● 2 chairs in exam room 3
● 1 chair per recovery room (6 total)
Alternative 2: Maximum Resources
![Page 33: Improving Patient Wait Times for OncologyImproving Patient Wait Times for Oncology Team 29 VA Process Sana Fathima, Courtney Hall, Ousmane Kaba, Gun Hee Lee, Zeba Munshi, Christopher](https://reader030.fdocuments.net/reader030/viewer/2022040819/5e6677e61e6e765f5d6c3deb/html5/thumbnails/33.jpg)
Simulation - Results
33
*The scenario that includes the expansion has 30% more patients with 10 more chairs/beds, 4 more physicians, 2 more triage nurses from 6AM-3PM
See Appendix page 42 for break down of time spent
20 33 7
47 34 5
Scheduling
Guidelines + Expansion
18 29 --
Simulation Scenario Testing Results: Time Spent from Front Desk to Treatment
*All scenarios include scheduling guidelines
![Page 34: Improving Patient Wait Times for OncologyImproving Patient Wait Times for Oncology Team 29 VA Process Sana Fathima, Courtney Hall, Ousmane Kaba, Gun Hee Lee, Zeba Munshi, Christopher](https://reader030.fdocuments.net/reader030/viewer/2022040819/5e6677e61e6e765f5d6c3deb/html5/thumbnails/34.jpg)
Valuation
34
● Current Time: 99 minutes
● New Improved Time: 67 minutes
● Time saved: 32 minutes
Time Saved: Scheduling
● Nurse Overtime: $90,624/year
● Reducing time to 67
minutes will save:
$186,500/year
Savings: Scheduling
1
● Current Time : 99 minutes
● New Improved Time: 37 minutes
● Time saved: 62 minutes
Time Saved: 1 + CBOC
● Nurse Overtime: $90,624/year
● Reducing time to 37
minutes will save:
$256,439/year
Savings: 1 + CBOC
2
● Current Time: 99 minutes
● New Improved Time: 24 minutes
● Time saved: 75 minutes
Time Saved: 2 + Expansion
● Nurse Overtime: $90,624/year
● Reducing time to 24
minutes will save:
$332,204/year
Savings: 2 + Expansion
3
$277,124 $347,063 $422,828
![Page 35: Improving Patient Wait Times for OncologyImproving Patient Wait Times for Oncology Team 29 VA Process Sana Fathima, Courtney Hall, Ousmane Kaba, Gun Hee Lee, Zeba Munshi, Christopher](https://reader030.fdocuments.net/reader030/viewer/2022040819/5e6677e61e6e765f5d6c3deb/html5/thumbnails/35.jpg)
Valuation
35
● Current Time: 99 minutes
● New Improved Time: 67 minutes
● Time saved: 32 minutes
Time Saved: Scheduling
● Nurse Overtime: $90,624/year
● Reducing time to 67
minutes will save:
$186,500/year
Savings: Scheduling
● Current Time: 99 minutes
● New Improved Time: 24 minutes
● Time saved: 75 minutes
Time Saved: 2 + Expansion
● Nurse Overtime: $90,624/year
● Reducing time to 24
minutes will save:
$332,204/year
Savings: 2 + Expansion
● Current Time : 99 minutes
● New Improved Time: 37 minutes
● Time saved: 62 minutes
Time Saved: 1 + CBOC
● Nurse Overtime: $90,624/year
● Reducing time to 37
minutes will save:
$256,439/year
Savings: 1 + CBOC
$277,124 $422,828$347,063
1 2 3
![Page 36: Improving Patient Wait Times for OncologyImproving Patient Wait Times for Oncology Team 29 VA Process Sana Fathima, Courtney Hall, Ousmane Kaba, Gun Hee Lee, Zeba Munshi, Christopher](https://reader030.fdocuments.net/reader030/viewer/2022040819/5e6677e61e6e765f5d6c3deb/html5/thumbnails/36.jpg)
36
Thank you for your time!
![Page 37: Improving Patient Wait Times for OncologyImproving Patient Wait Times for Oncology Team 29 VA Process Sana Fathima, Courtney Hall, Ousmane Kaba, Gun Hee Lee, Zeba Munshi, Christopher](https://reader030.fdocuments.net/reader030/viewer/2022040819/5e6677e61e6e765f5d6c3deb/html5/thumbnails/37.jpg)
37
Appendix- Flow
Mean: 70 minutes
![Page 38: Improving Patient Wait Times for OncologyImproving Patient Wait Times for Oncology Team 29 VA Process Sana Fathima, Courtney Hall, Ousmane Kaba, Gun Hee Lee, Zeba Munshi, Christopher](https://reader030.fdocuments.net/reader030/viewer/2022040819/5e6677e61e6e765f5d6c3deb/html5/thumbnails/38.jpg)
38
Appendix- Flow
Mean: 99 minutes
![Page 39: Improving Patient Wait Times for OncologyImproving Patient Wait Times for Oncology Team 29 VA Process Sana Fathima, Courtney Hall, Ousmane Kaba, Gun Hee Lee, Zeba Munshi, Christopher](https://reader030.fdocuments.net/reader030/viewer/2022040819/5e6677e61e6e765f5d6c3deb/html5/thumbnails/39.jpg)
39
Appendix- Flow
Mean: 146 minutes
![Page 40: Improving Patient Wait Times for OncologyImproving Patient Wait Times for Oncology Team 29 VA Process Sana Fathima, Courtney Hall, Ousmane Kaba, Gun Hee Lee, Zeba Munshi, Christopher](https://reader030.fdocuments.net/reader030/viewer/2022040819/5e6677e61e6e765f5d6c3deb/html5/thumbnails/40.jpg)
40
Appendix- LabBelow are the percentages of patients who wait longer than an hour for lab results by day.
![Page 41: Improving Patient Wait Times for OncologyImproving Patient Wait Times for Oncology Team 29 VA Process Sana Fathima, Courtney Hall, Ousmane Kaba, Gun Hee Lee, Zeba Munshi, Christopher](https://reader030.fdocuments.net/reader030/viewer/2022040819/5e6677e61e6e765f5d6c3deb/html5/thumbnails/41.jpg)
41
Appendix- Simulation Inputs (part 1 of 2)
Below is part one of the input distributions and data sources for the simulation model.
![Page 42: Improving Patient Wait Times for OncologyImproving Patient Wait Times for Oncology Team 29 VA Process Sana Fathima, Courtney Hall, Ousmane Kaba, Gun Hee Lee, Zeba Munshi, Christopher](https://reader030.fdocuments.net/reader030/viewer/2022040819/5e6677e61e6e765f5d6c3deb/html5/thumbnails/42.jpg)
42
Appendix- Simulation Inputs (part 2 of 2)
Below is part two of the input distributions and data sources for the simulation model.
![Page 43: Improving Patient Wait Times for OncologyImproving Patient Wait Times for Oncology Team 29 VA Process Sana Fathima, Courtney Hall, Ousmane Kaba, Gun Hee Lee, Zeba Munshi, Christopher](https://reader030.fdocuments.net/reader030/viewer/2022040819/5e6677e61e6e765f5d6c3deb/html5/thumbnails/43.jpg)
NormalMean: 252 minSD: 119 min
43
Appendix- Simulation Validation
BetaMean: 247 minSD: 101 min
Kolmogorov-Smirnov Test:
Test Statistic: 0.0221Failed to reject Null Hypothesis
Anderson-Darling Test:
Test Statistic: 0.31020Failed to reject Null Hypothesis
Monday Simulation Output
Monday Patient Data
![Page 44: Improving Patient Wait Times for OncologyImproving Patient Wait Times for Oncology Team 29 VA Process Sana Fathima, Courtney Hall, Ousmane Kaba, Gun Hee Lee, Zeba Munshi, Christopher](https://reader030.fdocuments.net/reader030/viewer/2022040819/5e6677e61e6e765f5d6c3deb/html5/thumbnails/44.jpg)
BetaMean: 239 minSD: 125 min
44
Appendix- Simulation Validation
BetaMean: 233 minSD: 99.2 min
Kolmogorov-Smirnov Test:
Test Statistic: 0.01983Failed to reject Null Hypothesis
Anderson-Darling Test:
Test Statistic: 1.10846Failed to reject Null Hypothesis
Tuesday Simulation Output
Tuesday Patient Data
![Page 45: Improving Patient Wait Times for OncologyImproving Patient Wait Times for Oncology Team 29 VA Process Sana Fathima, Courtney Hall, Ousmane Kaba, Gun Hee Lee, Zeba Munshi, Christopher](https://reader030.fdocuments.net/reader030/viewer/2022040819/5e6677e61e6e765f5d6c3deb/html5/thumbnails/45.jpg)
Weibull Mean: 205 minSD: 106 min
45
Appendix- Simulation Validation
BetaMean: 217 minSD: 95.4 min
Kolmogorov-Smirnov Test:
Test Statistic: 0.0263Failed to reject Null Hypothesis
Anderson-Darling Test:
Test Statistic: 0.98035Failed to reject Null Hypothesis
Thursday Simulation Output
Thursday Patient Data
![Page 46: Improving Patient Wait Times for OncologyImproving Patient Wait Times for Oncology Team 29 VA Process Sana Fathima, Courtney Hall, Ousmane Kaba, Gun Hee Lee, Zeba Munshi, Christopher](https://reader030.fdocuments.net/reader030/viewer/2022040819/5e6677e61e6e765f5d6c3deb/html5/thumbnails/46.jpg)
ErlangMean: 201 minSD: 109 min
46
Appendix- Simulation Validation
BetaMean: 214 minSD: 93 min
Kolmogorov-Smirnov Test:
Test Statistic: 0.01369Failed to reject Null Hypothesis
Anderson-Darling Test:
Test Statistic: 0.32196Failed to reject Null Hypothesis
Friday Simulation Output
Friday Patient Data
![Page 47: Improving Patient Wait Times for OncologyImproving Patient Wait Times for Oncology Team 29 VA Process Sana Fathima, Courtney Hall, Ousmane Kaba, Gun Hee Lee, Zeba Munshi, Christopher](https://reader030.fdocuments.net/reader030/viewer/2022040819/5e6677e61e6e765f5d6c3deb/html5/thumbnails/47.jpg)
Appendix- Expansion (part 1 of 2)
Clearance Measurements Length (ft) Width (ft)Chair 8 8Bed 11.5 9
Actual Measurements Length (ft) Width (ft)Chair (Oncology) 7 6Bed (Oncology) 11.5 9Chair (GI Space) 8 7.5Bed (GI Space) Not Measured
Cost Parameters PriceCost of Chair $1,500.00Cost of Bed $3,000.00
Portable Oxygen + suction + air $300.00
47
The resources, costs, and measurements are listed below, as well as the expansion space.
![Page 48: Improving Patient Wait Times for OncologyImproving Patient Wait Times for Oncology Team 29 VA Process Sana Fathima, Courtney Hall, Ousmane Kaba, Gun Hee Lee, Zeba Munshi, Christopher](https://reader030.fdocuments.net/reader030/viewer/2022040819/5e6677e61e6e765f5d6c3deb/html5/thumbnails/48.jpg)
Appendix- Expansion (part 2 of 2) Alternatives Room 1 Room 2 Room 3 Recovery Rooms Added beds Added chairs Estimated Cost
1 2 beds, 2 chairs 4 chairs 2 chairs 6 chairs 2 14 $31,800.002 2 beds, 2 chairs 2 beds 2 chairs 6 chairs 4 10 $31,200.003 2 beds, 2 chairs 1 bed, 1 chair 2 chairs 6 chairs 3 11 $29,700.004 2 beds, 2 chairs 4 chairs 1 bed 6 chairs 3 12 $31,500.005 2 beds, 2 chairs 2 beds 1 bed 6 chairs 5 8 $30,900.006 2 beds, 2 chairs 1 bed, 1 chair 1 bed 6 chairs 4 9 $29,400.007 4 chairs 4 chairs 2 chairs 6 chairs 0 16 $28,800.008 4 chairs 2 beds 2 chairs 6 chairs 2 12 $28,200.009 4 chairs 1 bed, 1 chair 2 chairs 6 chairs 1 13 $26,700.00
10 4 chairs 4 chairs 1 bed 6 chairs 1 14 $28,500.0011 4 chairs 2 beds 1 bed 6 chairs 3 10 $27,900.0012 4 chairs 1 bed, 1 chair 1 bed 6 chairs 2 11 $26,400.0013 1 bed 1 bed 1 bed 6 chairs 3 6 $20,700.0014 Exam room Exam room Exam room 6 chairs 0 6 $10,800.0015 2 beds, 2chairs Exam room Exam room 6 chairs 2 8 $27,000.0016 Exam room Exam room 1 bed 6 chairs 1 6 $20,100.0017 Exam room 2 beds Exam room 6 chairs 2 6 $23,400.0018 Exam room 1 bed, 1 chair Exam room 6 chairs 1 7 $21,900.0019 2 beds, 2 chairs 1 bed, 1 chair Exam room 6 chairs 3 9 $29,100.00 48
![Page 49: Improving Patient Wait Times for OncologyImproving Patient Wait Times for Oncology Team 29 VA Process Sana Fathima, Courtney Hall, Ousmane Kaba, Gun Hee Lee, Zeba Munshi, Christopher](https://reader030.fdocuments.net/reader030/viewer/2022040819/5e6677e61e6e765f5d6c3deb/html5/thumbnails/49.jpg)
Appendix - Simulation Results
49
Check-In Wait Time
(minutes)
Check-In Process
Time(minutes)
TriageWaiting Room
(minutes)
Triage Process
Time(minutes)
Treatment Waiting Room
(minutes)
Lab Process
Wait Time(minutes)
Check-In to Treatment
Center(minutes)
Current State 3 5 3 7 47 30 95
Scheduling Guidelines 3 5 7 7 15 30 67
CBOC Patients 3 5 7 7 15 0 37
Expansion* 3 5 1 7 8 30 54
CBOC Patients with Expansion*
3 5 1 7 8 0 24
*The scenario that includes the
expansion has 30% more patients with 10 more chairs/beds, 4 more physicians, 2 more triage nurses
from 7AM-3PM
The table shows a detailed breakdown of process and waiting times from Check-in to Treatment for each scenario tested.
![Page 50: Improving Patient Wait Times for OncologyImproving Patient Wait Times for Oncology Team 29 VA Process Sana Fathima, Courtney Hall, Ousmane Kaba, Gun Hee Lee, Zeba Munshi, Christopher](https://reader030.fdocuments.net/reader030/viewer/2022040819/5e6677e61e6e765f5d6c3deb/html5/thumbnails/50.jpg)
Appendix- Nurse Overtime
50
Cost Comparison of Overtime Hours
Total Overtime of all nurses (hours:minutes)
1829:55
Additional cost spent on overtime (Assume 1.5 x $40 nurse hourly wage x
1829:55)
$109,795
Salary of 1 nurse (total over 63 weeks)$100,800
The table shows overtime data collected over 63 weeks
![Page 51: Improving Patient Wait Times for OncologyImproving Patient Wait Times for Oncology Team 29 VA Process Sana Fathima, Courtney Hall, Ousmane Kaba, Gun Hee Lee, Zeba Munshi, Christopher](https://reader030.fdocuments.net/reader030/viewer/2022040819/5e6677e61e6e765f5d6c3deb/html5/thumbnails/51.jpg)
Appendix- CBOC Patient Densities
51
The figure shows the number of patients that are within a 20 mile radius of a CBOC. 80% of patients fall within this range. A random sample of 526 patient zip codes were used.
![Page 52: Improving Patient Wait Times for OncologyImproving Patient Wait Times for Oncology Team 29 VA Process Sana Fathima, Courtney Hall, Ousmane Kaba, Gun Hee Lee, Zeba Munshi, Christopher](https://reader030.fdocuments.net/reader030/viewer/2022040819/5e6677e61e6e765f5d6c3deb/html5/thumbnails/52.jpg)
Appendix- Indirect Cost
52
Scheduling guideline
CBOC guideline
Both
![Page 53: Improving Patient Wait Times for OncologyImproving Patient Wait Times for Oncology Team 29 VA Process Sana Fathima, Courtney Hall, Ousmane Kaba, Gun Hee Lee, Zeba Munshi, Christopher](https://reader030.fdocuments.net/reader030/viewer/2022040819/5e6677e61e6e765f5d6c3deb/html5/thumbnails/53.jpg)
Appendix- VistA Scheduling Grid
53
Before
After
Here is a before and after look of the scheduling grid design.