Prioritization system of patients on surgical

waiting list
The aim of this project is schedule patients using prioritization
Angulo C. Lombeida J. criteria. It also include a management tool of surgical waiting list in
cargrang@espol.edu.ec jhamilom@espol.edu.ec order to reduce waiting time for surgery. This study was performed
in a third level hospital.
DEFINE
Problem 4 W+ H VOC

Time Series Plot of Patients waiting for surgery

180

160

140

Problem Statement
Q uantity of patients

120
𝑋ത𝑤𝑚 = average time that a patient waits for
100
surgery
80 General objective
σ 𝑚𝑜𝑛𝑡ℎ𝑠 𝑜𝑓 𝑤𝑎𝑖𝑡𝑖𝑛𝑔
𝑋ത𝑤𝑚 = Reduce the average time that a patient wait from surgical record
60 𝑡𝑜𝑡𝑎𝑙 𝑝𝑎𝑡𝑖𝑒𝑛𝑡𝑠
filling out until surgery in order to improve healthcare services
40
𝑋ത𝑤𝑚 = 2,86 months

20 Specific objectives
0 •To establish prioritization criteria for scheduling patients on
may jul sep nov ene mar may jul sep surgical waiting list
Month
201 201 •Propose improvements actions for the appropriate management of
5 6 the surgical waiting list

MEASURE
Elapsed days from surgical record filling out until is register in the surgical waiting list Variable 1 Variable 2 Elapsed days from patient registration in surgical waiting list until surgery

>30 Dias >100 Dias

5% 6%
>7 Dias
3%

POLICY
0 Dias
>7 Dias< 55%
31% Average time
that a patient
wait from
surgical record
filling until
surgery
If the surgical record is didn’t carried to Surgical programming, the patient is not
registered in the surgical waiting list.

ANALYZE
FMEA
O
D
S C
Workshop with the stakeholders E C
E
T Critical causes
V U
POTENCIAL EFFECTS E
POTENCIAL FAILURE MODE NPR
E R
C

Potencial OF FAILURE R R
T
c3 c6
I
T
E
N
I c1
causes Y C
O
N
E
c13 c5
There is no record of
c1 c3 c6 The date of the preoperative how long the patient has
6 5 8 240
diagnosis is not recorded been waiting to be
c2 c13 c5 operated on 5 WHY’s
1 2 3 4 5
Cause

The surgery record is not taken to The patient is not

Why? Why? Why? Why? Why?

c7 c10 c8 Dr does not anticipate

the surgical programming considered to be 7 4 7 196

Add patients without Surgery requirements
No inputs and resources the resources and There is not a manage
Changes in surgical programming considering transoperative are not reviewed at the
are managed or lack of supplies need for surgical of SWL
needs surgical committee

department operated
stock intervention

c12 c11 c15

Scheduling patients without any Prolonged stay on the
8 8 7 448 Verified causes
c9 c14 c4 schedule method surgical waiting list
Stakeholders
c1• There are not a prioritization criteria
► Surgical Programming department Surgeries suspended
15 causes are found with the Not have a visual warning about the time that
Schedule unsuitable patients 8 5 8 320 c2•
► Operating rooms stakeholders help The patient returns to do
patient wait
medical examinations
► Quality department c3• Ambiguity or lack of fields in the operative part
► Admissions department Schedule patients without Aggravate the patient's
10 10 8 800 • There is not a manage of SWL
medical priority criteria situation c4

IMPROVE: PROPOSALS
c1 Prioritization Criteria c3 New surgical record format c4 Surgical Waiting List Management

22%
Life quality impact
45% • Add patients unsuitable for surgery.
Waiting risk • Physician stay with the surgical record
33% • Patients are not registered in SWL
Waiting time on surgical • Surgical record filled out incorrectly
waiting list

Physicians leader qualified each criteria to calculate its weight Set Policy

c2 Color-tag system
COLOR TAG SYSTEM
0,444 0,333 0,222 1
NON URGENCYCV LESS
0,444 RE URGENCY
0,333 T_LEQ
0,222 1P URGENCY
CV 1 RE 1 60
T_LEQ 14
0,444 0,333 0,222 1P
CV12 RE12 60
T_LEQ
15
14
P
123 123 60
60 16
15
14 0< X >16 Socialization and training
23 23 60 16
15 0< X >16
31 31 60
120 16
27 0< X >16

12 12 120 28
27
123 123 120
120 28
27
29 16< X >29
23 23 120 28
29 16< X >29
31 31 120
180 29
41 16< X >29 All the fields has been included, and
12 12 180 42
41 the ambiguity fields were erased
123 123 180
180 42
41 X >29
23 23 180 42 X >29

Results
3 3 180 42 X >29

CONTROL Elapsed days from surgical record filling Elapsed days from patient
Surgical waiting list management control out until is register in the SWL registration in SWL until surgery
Surgical Scheduling Assistant
>30 Dias >100 > 7 Días
5% Dias >7 Días<
Dates of: >7 3%
6% 9%
Dias
3% 0 Días
0 Dias 88%
>7
▪ Registration in surgical
55%
Dias<
31%
waiting list
▪ Surgical record fill Before After
BEFORE AFTER
▪ Surgery
CONCLUSIONS:
▪ With the policy Physician fill the surgical record correctly and deliever to the
Simulation Using Promodel Software surgical scheduling department in a time less than 7 days.
▪ Establishing prioritization criteria, patients will reduce their surgery waiting time
Training
into a 15% on average without any extra cost.

RECOMMENDATIONS:
▪ Develop a software application on the hospital main information system based
on the prototype created to remove the surgical record paper and change it for a
digital surgical record.
▪ Update the surgical map to level the demand with the supply.

Industrial Engineering