title: Electronic Tracking of Patients in an Outpatient Ophthalmology Clinic to Improve Efficient Flow: A Feasibility Analysis and Benchmarking Study.
abstract: BACKGROUND
  Real-time location systems (RTLS) and Lean management approaches have been employed to improve patient flow in clinical settings. This study explored the feasibility of using these methodologies in an outpatient resident ophthalmology clinic.
  
  
  METHODS
  Patients, providers, and staff in Wilmer Eye Institute General Eye Services Clinic were provided RTLS tags to track their movement throughout the clinic after observational studies modeling flow were conducted. Tracking data guided changes for clinic processes based on Lean management approaches, including reorganization of the reception desk, consolidation of forms, creation of task sheets to improve communication, installation of door flags on examination rooms, and training the staff in service excellence. Tracking was repeated after changes were implemented. A patient satisfaction survey was also conducted prior to and after the changes.
  
  
  RESULTS
  After intervention, significant increases were measured in the average time patients spent in the clinic (99.3 minutes vs 112.8 minutes). Significant decreases were seen in the times patients spent with the optometrists (15.4 minutes vs 12.1 minutes), testing (24.7 minutes vs 23.0 minutes), and together with both the attending and the resident (8.3 minutes vs 5.8 minutes). The patient satisfaction survey indicated improvements in patients' perception of the helpfulness/friendliness of the staff, the length of time patients perceived they waited, and overall clinic experience.
  
  
  CONCLUSIONS
  Both RTLS and Lean management approaches may be feasible ways to track and improve patient flow and satisfaction if certain limitations can be overcome. This is the first published report describing these approaches applied to an academic ophthalmology clinic in the United States.
authors.affiliation: Wilmer Eye Institute (Drs Singman and Boland, Ms Shafer, and Messrs Greenbaum and Thomas) and Division of Health Sciences Informatics (Dr Boland), Johns Hopkins University School of Medicine, Baltimore, Maryland (Mr Vakili); Ophthalmology Department, Northwestern University, Chicago, Illinois (Ms Haberman); Operations Integration, Johns Hopkins Health System, Baltimore, Maryland (Messrs Appelbaum and Toerper and Ms Adelman); Johns Hopkins School of Public Health, Baltimore, Maryland (Ms Tian); Pediatric Emergency Department (Ms Katz) and Emergency Medicine Department (Mr Toerper), Johns Hopkins Hospital, Baltimore, Maryland; and Johns Hopkins Health System, Baltimore, Maryland (Ms Kelsay).
authors.forename: Eric L
authors.initials: EL
authors.lastname: Singman
authors.forename: Chantal V
authors.initials: CV
authors.lastname: Haberman
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Appelbaum
authors.forename: Jing
authors.initials: J
authors.lastname: Tian
authors.forename: Karen
authors.initials: K
authors.lastname: Shafer
authors.forename: Matthew
authors.initials: M
authors.lastname: Toerper
authors.forename: Susanne
authors.initials: S
authors.lastname: Katz
authors.forename: Maureen
authors.initials: M
authors.lastname: Kelsay
authors.forename: Michael V
authors.initials: MV
authors.lastname: Boland
authors.forename: Milton
authors.initials: M
authors.lastname: Greenbaum
authors.forename: Rebecca
authors.initials: R
authors.lastname: Adelman
authors.forename: Richard C
authors.initials: RC
authors.lastname: Thomas
authors.forename: Sharif
authors.initials: S
authors.lastname: Vakili
mesh_terms: D000554:Ambulatory Care Facilities; D019985:Benchmarking; D004582:Electronics, Medical; D004867:Equipment Design; D006801:Humans; D009885:Ophthalmology; D010045:Outpatients; D010355:Patient Identification Systems / Q000379:methods*; D011795:Surveys and Questionnaires