title: THINKING LEAN: Improving Vitreoretinal Clinic Efficiency by Decentralizing Optical Coherence Tomography.
abstract: OBJECTIVE
  Patients in vitreoretinal clinic have long wait times that could be reduced by improving the efficiency of patient flow. The objective of this study was to determine whether decentralizing optical coherence tomography (OCT) into the technicians' room would reduce patient wait times and improve clinic efficiency.
  
  
  METHODS
  Randomized, single-center, clinical trial for 1 month without follow-up at Byers Eye Institute at Stanford. Subjects were return patients of three vitreoretinal specialists in March 2013. The intervention consisted of decentralizing OCT devices from the central photography suite into the technician screening rooms. Total clinic times and total wait times throughout subject appointments were recorded and compared with the control group (centralized photography suite). Secondary outcomes included frequency of injections, procedures, and primary diagnosis codes.
  
  
  RESULTS
  Decentralized OCT reduced patient wait times by 74% and reduced total clinic appointment time by 36%. Subjects in the intervention arm experienced significantly reduced total wait time (mean difference = 15.9 minutes, P < 0.0001) and total time in clinic (mean difference = 22.9 minutes, P < 0.0001).
  
  
  CONCLUSIONS
  Decentralized OCT represents the application of lean process concepts to improve vitreoretinal clinic efficiency. Decentralized OCT reduced both the total wait time and total time in clinic for return patients in a vitreoretinal clinic.
authors.affiliation: Byers Eye Institute at Stanford, Stanford University School of Medicine, Palo Alto, California.
authors.forename: Natalia F
authors.initials: NF
authors.lastname: Callaway
authors.forename: Joyce H
authors.initials: JH
authors.lastname: Park
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Maya-Silva
authors.forename: Theodore
authors.initials: T
authors.lastname: Leng
mesh_terms: D000368:Aged; D000554:Ambulatory Care Facilities / Q000592:standards*; D003941:Diagnostic Techniques, Ophthalmological / Q000592:standards*; D017598:Efficiency, Organizational / Q000592:standards*; D005260:Female; D005451:Fluorescein Angiography; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010781:Photography; D013996:Time and Motion Studies; D041623:Tomography, Optical Coherence / Q000592:standards*; D057586:Vitreoretinal Surgery; D014850:Waiting Lists; D057188:Workflow