Northeastern Illinois University

Production and Operations Management

PATA Case Study

03/05/2019

By:

Brittanai Brooks
Chassidy Jones
Jory Simmons
Mohammad Zatar
 Brittanai Brooks

Chassidy Jones

Jory Simmons

Mohammad Zatar

PATA Case Study

Introduction (Chassidy):

MGH is the third largest hospital in the United States and has over 950 beds in the facility. Currently, the
clinic has an outpatient center designated for specializing in pre-admission tests (PATA) for patients that
require the use of anesthesia during surgical operations. Patients primarily consist of individuals that are
referred to the pre- admission testing area by their surgeons as a preoperative preventative measure to
ensure that the patients are safe to receive doses of anesthesia. Since the majority of their patients are
surgeon referrals, the demand for PATA screenings is very high due to the liability involved. Generally,
all of the patients will go through a process of checking their vitals, visiting with a RN, and being
examining by the doctor. The process of completing each station is verified upon check out by showing
proof that your task list is completed and signed by the appropriate staff at each station. While the PATA
is responsible for performing check-ups on approximately 43% of patients requiring anesthesia at MGH,
the clinic has some improvements it must consider in order to create a more positive experience for all
of the patients.

Problems/Issues:
Of the almost 4 hours or more patients spend in the clinic, only about 2.5 hours is apart of the actual
appointment with an actual person. This caused some patients to cancel appointments. Also, surgeries
saw cancellations as well when pre-surgery work ups were missing patient information. Extra time was
also added when nurses and anesthesiologists needed to speak to one another regarding patients.
Overall, the long wait times are a problem that Massachusetts General Hospital and would need to
improve this.

Options/Analysis:

Alternative 1

Extend work time until 6:30 p.m. to allow additional time for the Registered Nurses and Medical Doctors
to complete their task without to prevent a large que to form. This will reduce the impact of variability
on wait time. Increasing the work hours will also increase appointment time between 30-45 minutes.
The

Current arrival time with non-lunch hours 4 patients every 30 minutes for a total of 8 patients per hour.
Lunch hours consist of 4 patients per hour with 2 patients every 30 minutes. With extended hours the
new time would be for non-lunch hours 5.3 patients per hour for a total of 4 patients every 45 minutes.
For lunch hours 2.67 patients per hour for a total of 2 patients every 45 minutes. To meet the
expectations of seeing 56 patients a day the schedule would have to be extended to 6:30 p.m. To
calculate you would apply Little’s Laws and the queing model. This will reduce the average waiting time
from 1 hour to less than 15 minutes. Increasing the wait time will increase the cost of the overhead.
They will all cause a strain on employee satisfaction do to permanent extension of hours throughout the
week.

Total Average Wait Time (Regular Hours): 58.17 minutes

Total Average Wait Time Extended Hours 13.37 minutes

Queue Time-Non-Lunch:

N
Vitals + EKG P MD Blood Work

a 7.5 8.6 8.6

Std Dev a 8.9 1.7 3.4

CVa 1.2 .2 0.4

p 10 64 6

Std Dev
p 3.5 29 2

CVp 0.35 0.45 0.33

M 2 8 3

U 0.67 0.93 0.23

11.7
TQ 6.38 40 7 0.02

Queue Time Extend Time:

Vitals +
EKG NP MD Blood Work

a 11.3 11.3 11.3 11.3

 Std Dev a 8.9 11.3 2.3 4.5

CVa 0.8 1 0.2 0.4

p 10 43 64 6

Std Dev
p 3.5 21 29 2

CVp 0.35 0.49 0.45 0.33

m 2 5 8 3

u 0.44 0.76 0.71 0.18

Tq 1.01 11.26 1.09 0.01

Alternative 2

The 2nd alternative is to add an additional Registered Nurse or an additional Medical Doctor. The current
utilization of the nurses is at 100% during both non-lunch and lunch hours.

The arrival time of patients is as follows:

7am-12pm= 8 patients/hr non-lunch hours, 12pm-2pm= 4 patients/hr lunch hours, 2pm-3pm= 8
patients/hr Non-Lunch Hours

The capacity for RN station during the non-lunch hours is = 7 patients/hr. The Capacity for RN station
during the lunch hours is = 2.8 patients/hr. Based on the information the backlog is 7am-12pm Non-
Lunch hours= 1patient/hr x 5 hours = 5 patients, 12pm-2pm Lunch Hours=1.2patients/hr x 2 hours = 2.4
patients, 2pm-3pm Non-Lunch hours = 1 patient/hr x 1 = 1 patient. There will be 8.4 patients on the RN
station at 3pm and there will be extra hours needed to finish this backlog. The inventory will finish
around 4:12pm, since the capacity of the system is 7pts/hr.

The Capacity for RN station during the non-lunch hours is = 7 patients/hr. The Capacity for RN station
during the lunch hours is = 2.8 patients/hr7 patients/hr x 7.2 hours Non-lunch hours; 7am-12pm and
2pm-4:12pm =50.4 patients during the non-lunch hours.  2.8 patients/hr x 2 lunch hours; 12-2pm =5.6
patients during the lunch hours

For Flow Rate: Total number of Patients/Total number of working hours = 50.4+5.6/9.2 =6.1 patients/hr
For wait time: Little’s Law, Inventory = Flow Rate x Flow Time In order to determine the wait time =
4.11/6.1= 0.67 hours or 40 mins.
If one nurse is added in during both lunch and non-lunch hours, Non-Lunch hours Capacity = 60/43mins
service rate x 5 number of RN = 8.37 patients/hr

Lunch hours Capacity = 60/43mins service rate x 3 number of RN = 4.2 patients/hr. Adding the one nurse
resolves the bottleneck at the RN station however you will have to add an additional MD because it will
create build up.  The Current MD utilization is also high during non-lunch hours. We can compute
utilization with the following calculations:

Total service time is 64 minutes per patient 10 min review, 37 min average exam, 17 min post-exam
documentation. This results in a rate of .94 patients per hour 60 min/hour / 64 min/patient. Using this
rate gives us a non-lunch capacity of 7.5 patients per hour .94 x 8 MDs and a lunch capacity of 3.75
patients per hour .94 x 4 MDs.  Since the RN capacity limits flow rate, flow during non-lunch hours is 7
patients per hour, and flow during lunch hours is 2.8 patients per hour.

To determine utilization, divide flow rate by capacity: Utilization = Flow Rate / Capacity Non-lunch
utilization = 7 patients per hour / 7.5 patients per hour = .93 Lunch utilization = 2.8 patients per hour /
3.75 patients per hour = .75

Since MD utilization has not reached its bottleneck and this step does not act as a bottleneck for
subsequent steps, adding an additional MD will not significantly affect the process. We can also see how
this step affects queue times by inputting the updated utilization rates into the queue time formula.
Non-lunch capacity with an additional MD is as .94 x 9 MDs = 8.46 patients per hour worth a utilization
rate of .83 Inputting that utilization rate into our queue time formula will result in a waiting time of 2.25
minutes.

Flow Rate and Utilization:

Vitals +
EKG NP MD Blood Work

a 11.3 11.3 11.3 11.3

Std Dev a 8.9 11.3 2.3 4.5

CVa 0.8 1 0.2 0.4

p 10 43 64 6

Std Dev
p 3.5 21 29 2

CVp 0.35 0.49 0.45 0.33

m 2 5 8 3
 u 0.44 0.76 0.71 0.18

Tq 1.01 11.26 1.09 0.01

Conclusion:

The best option is to choose Alternative 2 based on our analysis.