University of Twente Student Theses


Re-Design of the Pre-Anesthetic Evaluation Clinic at Leiden University Medical Center

Zonderland, M.E. (2007) Re-Design of the Pre-Anesthetic Evaluation Clinic at Leiden University Medical Center.

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Abstract:Like many other hospitals, Leiden University Medical Center organizes preoperative screening for elective surgery patients in an outpatient clinic. The screening process involves a visit to the secretary, nurse and anesthesiologist. Patients either have an appointment or arrive on walk-in basis. Appointments originate partly from patients sent away previously by the secretary because it is too busy for instant evaluation, and partly from patients that need further preparation prior to their visit to the anesthesiologist. This preparation consists mainly of acquiring patient information from other doctors and/or hospitals. After the patient’s visit a significant amount of back-office activities has to be performed by staff. Prolonged patient waiting times and increasing workload for staff call for an improvement in the design of the clinic. By using a multi-class open queuing network model, critical factors influencing patient waiting time and staff workload are identified. Among these critical factors are the scheduling of appointments during periods of high walk-in arrivals, conflicting tasks to be performed by the secretary and ill preparation of appointment patients. Uncertainty about the medical condition of the patient results in long consultation times at the anesthesiologists. Furthermore patients can only be approved for surgery by the anesthesiologist if all test results are available. Since testing for appointment patients is carried out during the appointment and not during the first visit, test results become available a few days after the appointment, resulting in a list of patients to be approved. These patients have to be approved by another anesthesiologist than the one who performs the consultation. This causes irritation among the anesthesiologists since they consider it very undesirable to (dis)approve a patient they did not see themselves. Mid-2007 a new working routine resulting from this analysis was introduced at the clinic. The new working routine comes down to scheduling appointment patients during periods of low walk-in demand, and the nurse dismissing patients after she evaluated them, instead of the secretary sending patients away prior to any evaluation. If necessary, the nurse takes blood samples from the patient and decides if other measures should be taken prior to surgery. These test results are available when the appointment takes place, and therefore the anesthesiologist can immediately decide if the patient can undergo surgery. Patients are dismissed by the nurse if there are four or more patients already waiting for the anesthesiologist. A queuing model is used to enable a trade-off between patient waiting time for the anesthesiologist and the number of patients dismissed per hour by the nurses. Unfortunately the results of the model are inconclusive, so the current boundary of four patients is maintained. Subsequently a simulation study is performed to provide guidelines for the opening hours of the clinic. The current practice of the one hour closing for lunch results in long waiting times and discomfort for patients arriving around the lunch break. Various configurations for lunch are tested with the simulation model. An alternative set-up for lunch based on the outcomes of the simulation study, namely no closing and staff members having lunch in shifts based on profession, has been implemented recently. Preliminary experiences with the new routine, appointment system, and opening hours are very positive.
Item Type:Essay (Master)
Leiden University Medical Center
Faculty:EEMCS: Electrical Engineering, Mathematics and Computer Science
Programme:Applied Mathematics MSc (60348)
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