Research article summary (published 30 Oct 2009):

Redesign of a university hospital preanesthesia evaluation clinic using a queuing theory approach.

Full Abstract

BACKGROUND: Changes in patient length of stay (the duration of 1 clinic visit) as a result of the introduction of an electronic patient file system forced an anesthesia department to change its outpatient clinic organization. In this study, we sought to demonstrate how the involvement of essential employees combined with mathematical techniques to support the decision-making process resulted in a successful intervention. METHODS: The setting is the preanesthesia evaluation clinic (PAC) of a university hospital, where patients consult several medical professionals, either by walk-in or appointment. Queuing theory was used to model the initial set-up of the clinic, and later to model possible alternative designs. With the queuing model, possible improvements in efficiency could be investigated. Inputs to the model were patient arrival rates and expected service times with clinic employees, collected from the clinic's logging system and by observation. The performance measures calculated with the model were patient length of stay and employee utilization rate. Supported by the model outcomes, a working group consisting of representatives of all clinic employees decided whether the initial design should be maintained or an intervention was needed. RESULTS: The queuing model predicted that 3 of the proposed alternatives would result in better performance. Key points in the intervention were the rescheduling of appointments and the reallocation of tasks. The intervention resulted in a shortening of the time the anesthesiologist needed to decide upon approving the patient for surgery. Patient arrivals increased sharply over 1 yr by more than 16%; however, patient length of stay at the clinic remained essentially unchanged. If the initial set-up of the clinic would have been maintained, the patient length of stay would have increased dramatically. CONCLUSIONS: Queuing theory provides robust methods to evaluate alternative designs for the organization of PACs. In this article, we show that queuing modeling is an adequate approach for redesigning processes in PACs.

Author information

Author/s: Zonderland, Maartje E (ME); Boer, Fredrik (F); Boucherie, Richard J (RJ); de Roode, Annemiek (A); van Kleef, Jack W (JW);

Affiliation: Division I, Leiden University Medical Center, Leiden, The Netherlands. m.e.zonderland(-atsign-)lumc.n

Journal and publication information

Publication Type: Journal Article

Journal: Anesthesia and analgesia (Anesth Analg), published in United States. (Language: eng)

Reference: 2009-Nov; vol 109 (issue 5) : pp 1612-21

Dates: Created 2009/10/21; Completed 2009/11/05;

PMID: 19843799, status: MEDLINE (last retrieval date: 11/5/2009, IMS Date: )

Sourced from the National Library of Medicine. Abstract text and other information may be subject to copyright.

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MeSH headings (categories)

This article was linked to the MESH Headings shown below.

Adolescent Adult Anesthesia Department, Hospital - organization & administration Appointments and Schedules Decision Support Techniques Efficiency, Organizational Health Services Needs and Demand Health Services Research Hospitals, University - organization & administration Humans Length of Stay Medical Records Systems, Computerized - organization & administration

Medical Staff, Hospital - utilization Models, Organizational Office Visits Organizational Objectives Outpatient Clinics, Hospital - organization & administration Personnel Staffing and Scheduling Program Development Program Evaluation Reproducibility of Results Time Factors Time and Motion Studies Young Adult

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