141 Patient flow through a specialist heart failure clinic: a time and motion study. (4th June 2021) - Singhal, Arvind
Abstract : Introduction: Heart Failure (HF) is a chronic disease requiring regular monitoring and follow-up. Efficient utilisation of HF clinic time is essential for both HF patients and overburdened healthcare systems.We used time-and-motion studies, examining when (time) and how (motion) processes occur, in HF clinics at a specialist centre to identify areas for improved efficiency. Methods: Time-and-motion studies were conducted for four consultant-led HF clinics between 3rd December 2019 and 18th February 2020. Investigators noted the time of arrival and departure of each patient in the following clinical areas: electrocardiography (ECG), echocardiography, pacing department, consultation room, phlebotomy and x-ray. Estimated journey times for patients were calculated using Google Maps. Results: 60 patients attended appointments, and complete data were collected for 58 patients. The mean age was 66.6 years (SD±13.2), and 31% of patients were female. Patients spent a median of 103 minutes in the hospital (IQR 76 – 137 mins). Consultations were a median of 20 minutes long (IQR 14 – 27 mins), a median of 23 minutes after their scheduled time (IQR 6 – 74 mins) and a median of 63 minutes after patients arrived (IQR 34 to 93.5 mins). Figure 1 is a box plot showing the time patients spent undergoing each investigation on the same day as their appointment, alongside time spent in consultation. Blood tests and ECGs were the most common investigations coinciding with the hospital visit, performed with 41% and 40% of appointments respectively. A median of 8 minutes was spent by clinicians between patients. Patients' median total waiting time, i.e. time spent in hospital by patients outside of consultations and tests, was 64.5 minutes (IQR 31.75 – 94.5). New patients had longer consultations on average, with a median of 28.5 minutes (IQR 21.5 – 37) compared with 18.5 minutes for follow-up appointments (IQR 13 – 24) (p = 0.018) and spent longer in hospital than follow-up patients (median time 150.5 minutes vs 101 minutes, p = 0.040).Estimated travel times were a median of 45 minutes in each direction (IQR 29 – 87), and therefore a median of 90 minutes for a round trip. The estimated combination of travel time and time spent in hospital was a median of 190 minutes (IQR 149 – 283). Figure 2 illustrates the breakdown of total patient time spent in consultation, investigation, waiting or in travel. Conclusion: Most clinic appointments were delayed. Most patient time was spent in travel and waiting between activities on the day of a HF clinic appointment. There is huge scope for improvement in clinic efficiency and patient convenience by rationalisation of clinic services and increased use of telemedicine in HF. Conflict of Interest: Dr Singhal's salary is funded by a fellowship from Abbott