Emory

Dermatology
Clinic
S ARA ABBY CHAP MAN
J US TI N HUF F
F ELI X LAGARDE
S RI NI VAS P OLURU

About Emory
~27000 patient annually
13 doctors
The Problem
Project Goals
Identify bottlenecks and opportunities to improve workflow
Reduce patient time alone in room
Minimize overtime of EDC staff
Increase stakeholder satisfaction

The Typical Patient
Ratio of Face Time to
Scheduled Appointment
Duration
No-show Rates by
Weekday
15.76%
19.61%
15.84%
12.51%
13.30%
Mon Tue Wed Thur Fri
Mean no-show rate: 15.73%
Median no-show rate: 11.11%
Effect of Learners on Mean
Patient Time in Exam
Room
Simulation Model
General
Dermatology
Clinic
INPUTS
Patient schedule
Resource availability
Flow logic
Service times
OUTPUTS
Patient wait time
Time alone in room
Patient time in room
Total clinic duration
Simulation Model Validation
Correlation inspection approach
Observed system
input data
Observed system
input data
System output
data
Actual System
Simulation
Model
Model output
data
Compare
Scenarios 1 & 2
Scenarios 3 & 4
Scenarios 5 & 6
Recommendations
Institute policy in which learners are allowed to examine
patients only if clinic is running up to 10 min late
Schedule appointments 10 min earlier to reduce effect of
late arrivals on the system
Increase overbooking by an average of 1.5 patients
Impact of
Recommendations
No significant changes on:
Time to room
Total time in room
Total clinic duration
Significant increase in wait time to room of 8.0 min on
average
Clinic is able to attend 1.28 more patients on average
Summary of Findings
Resident impacts clinic duration
Patient spends a significant amount of time alone in the
room
Doctor face time is the key driver
System can cope with one additional patient at no
significant change in the clinic duration
Future Research
Converting patient wait time to value-added time
Analyzing how doctor time in exam room can be optimized
Investigating impact of resident presence on charting
quality and duration
Literature Review
Appendixes
Simulation Model
Change room and nurse allocation
Availability of resident/medical student
Change arrival and no-show pattern of patients
Change process duration for individual patients
Simulation Model Validation
0
20
40
60
80
Observed Simulation
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Wait Time to Room
95% CI Mean Mean
0
10
20
30
40
50
60
Observed Simulation
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Time Alone in Room
95% CI Mean Mean
0
50
100
150
200
Observed Simulation
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Total Time in Room
95% CI Mean Mean
0
100
200
300
400
Observed Simulation
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Total Clinic Time
95% CI Mean Mean
Simulated Scenarios
1. Clinics assigned 1.5 nurses
2. Learners examine patient if appointment is within a clinic lateness
threshold
3. Reduced variability in doctor face-time
4. Reduced mean doctor face-time
5. Patients scheduled prior to appointment time
6. Effect of decreased no-show rates in clinic duration
Impact of Final
Recommendations
Patient Time in Room
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Scenarios
Impact Final
Recommendations
Time to Room
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Scenarios
Impact Final
Recommendations
Total Clinic Duration
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Scenarios
Impact Final
Recommendations
Time Alone in Room
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Scenarios
Impact Final
Recommendations
Patient Serviced
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Scenarios
Effect of Learner Policies
Effect of Learner Policies
Effect of Learner Policies
Effect of Learner Policies
Reduce Variability Doctor
Face Time
Reduce Variability Doctor
Face Time
Reduce Variability Doctor
Face Time
Reduce Mean Doctor Face
Time
Reduce Mean Doctor Face
Time
Reduce Mean Doctor Face
Time
Reduce Mean Doctor Face
Time
Offset Appointment
Schedule
Offset Appointment
Schedule
Offset Appointment
Schedule
Effect of Reducing No-
Shows
Effect of Reducing No-
Shows
Effect of Reducing No-
Shows