title: Time in motion--testing efficiency in the dermatology procedure setting.
abstract: BACKGROUND
  Time-in-motion studies are validated means of determining efficiency and identifying sources of delay in a complex working environment. This analysis technique was applied to the dermatological surgical services provided by a university hospital department of dermatology.
  
  
  OBJECTIVE
  To identify any sources of low efficiency in dermatological surgical service provision and to make recommendations for increasing efficiency.
  
  
  METHODS
  Three types of dermatology surgical sessions were observed (consultant-led procedure list, nurse-led procedure list, and dermatology day-surgery list). Activities of staff were noted every 2 minutes throughout the sessions, and the data were compiled for processing in Microsoft Excel.
  
  
  RESULTS
  The results show that treatment of dermatology patients with day surgery was less efficient and cost effective than the other settings. Consultant-led procedure lists were the most efficient. Nurse-led sessions were less expensive but also less efficient than the consultant-led lists. Paperwork and generic communication were identified as major constituents of non-operating time.
  
  
  CONCLUSIONS
  The most efficient setting for dermatological procedures is the consultant-led procedure list. Paperwork and generic communication are identified as sources of service delay. Suggestions are made regarding possible solutions to these problems. We demonstrate the advantages of broad, objective appraisal of practice as opposed to numerical target-driven approaches that fail to address specific aspects of efficiency.
authors.affiliation: Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom. jonathan.fisher@nhs.net
authors.forename: Jonathan
authors.initials: J
authors.lastname: Fisher
authors.forename: Helen
authors.initials: H
authors.lastname: Lotery
authors.forename: Catriona
authors.initials: C
authors.lastname: Henderson
mesh_terms: D000556:Ambulatory Surgical Procedures / Q000191:economics; D003142:Communication; D003880:Dermatology / Q000191:economics / Q000458:organization & administration*; D017598:Efficiency, Organizational; D004739:England; D005568:Forms and Records Control; D006757:Hospital Units / Q000458:organization & administration*; D006785:Hospitals, University / Q000458:organization & administration; D006801:Humans; D007258:Informed Consent; D007400:Interprofessional Relations; D012871:Skin Diseases / Q000191:economics / Q000601:surgery*; D017748:Time Management