The problems faced by UHS that the triage system was designed to handle were:* The average waiting times that a patient experienced at the walk-in clinic. It took about 8-9 minutes for medical records to be retrieved, 5 minutes for them to be checked and about another 9 minutes for them to receive some sort of treatment. So, on an average it took 23 minutes of waiting between sign-in and treatment. For patients who wanted to see a specific doctor the time was almost 40 minutes.
* There was a large amount of dissatisfaction amongst patients, mainly due to 2 reasons – the waiting time as stated above and a complicated lengthy procedure. The patient had to go through waiting and sometimes seeing a nurse before actually meeting a doctor. Patients found this frustrating as they sometimes first be examined by a nurse and then referred to a doctor for which they would have to spend on average 10 minutes waiting.* The waiting time was often not related to the severity or nature of the problem.
Patients often found themselves waiting almost 55 minutes for just a prescription renewal or 30-40 minutes for treatment to a common cold.* There was often a repetition of diagnosis and patient questioning when a patient was referred to a doctor after seeing a nurse. Also, when a patient saw a nurse he/ she was often at the risk of receiving varying diagnosis/ treatment because the staff itself had varied experience and skillsThe success of the triage system can be judged by the problems that it fixed:* Some of the average waiting times actually increased slightly with the new system, pre-triage a patient waited 10 minutes to be seen by an MD and 24.5 minutes to be seen by a specific MD.
These times went up to 25.2 and 33.8 minutes respectively. Also, pre-triage a patient would wait on an average 13-14 minutes before first contact with an NP but post-triage this was almost 21-22 minutes.
* Almost 2/5th of the doctors are 100% occupied with walk-in appointments and decreasing the availability of the doctors for walk-in because of this actually increased the waiting time for a patient. This also caused some of the more ‘popular’ doctors to be overburdened and have a full load while others were left unutilized.* The waiting time for major and minor ailments remained the same. An example quoted shows a patient complaining that he has waited more than 30 minutes because he has a cold, has had 2 nurses attend to him but has not been diagnosed yet neither is there a doctor in sight.
* Triage coordinators started to use the system to maintain a flow between NPs and MDs going by overload situations rather than a means to provide the correct assistance and care that a patient sometimes needed. The MD/NP system was used to classify rather than to serve.* The expectations of the patients still lay with the traditional system, where they liked the contact with a doctor and got personalized attention. Doctors too started to misuse the system and schedule time unofficially with patients.
The system was meant to deliver the best possible care but was not.* The satisfaction levels though went up due to 2 reasons – the new system seemed more organized and there was an improvement in standardized treatment. The triage system defined 13 ailments which could be treated by the NPs and this cut down on patient wait time and necessity to see a doctor.On the whole the system seemed to have improved things and increased satisfaction, but on closer examination of the issues as above we find that it was only marginally effective and even created issues of its own.
Q2. Diagnose the underlying causes for the long waiting times in the Walk-In Clinic. Be specific and explain why.Ans2.
Lets look at some of the underlying causes for the long waiting times:1. Capacity Utilization – lets study the utilization of both doctors and nurses, keeping in mind that the average number of patients per week is 715 (143 patients per day*5 working days per week):* Doctors -They see 3.1 patients per hour and number of average physician hours available are 150 per week = on average 465 patients seen per weekMaximum doctor hours available = 12*22 = 264 less 22 hours reserve time = 252 hoursDoctor capacity = 3.1*252 = 781Therefore, doctor yield = 150/252 = 59.
5%Out of the 465 patients on an average 35% requested to be seen by a specific MD i.e. 163 patients.* Nurses -They see 1.
8 patients per hour and number of average NP hours available are 385 per week = 693 patients per weekNurse Capacity at 100% time utilization= 1540 patientsNurse yield or available time = 45%Of all patients seeing the NP’s only 5% are referred to a physician i.e. about 35 patientsThe figures above have only been used as a case in example of the under-utilization of the doctors and the potential utilization of the nurses. Let us explain this through some recommendations and their difficulties and costs:1.
Cut down on the administrative time spent by nurses – at the moment they are only available to devote 45% of their time to the walk-in clinic. If they can spend about 85-90% of time seeing patients then 1.8 more patients can be seen per hour extra they spend working. A good way to go about this would be to actually do a survey that of the total number of patients in a week over say 3-4 weeks and actually calculate how many were treated for the 13 ailments that have been defined for nurses, regardless of whether they were treated by a NP or MD.
Then calculate the amount of time it would take for nurses to see all those cases. Add to that the 5% of cases that get referred to a doctor on average and we have the total number of NP hours needed.Using this figure we can see how much of the nurses existing time needs to be increased OR we could hire more NPs. NP available time can be increased by hiring clerical staff to do the administrative work, which will be cheaper than NP time.
This system could be even further improved if the nurses’ ‘repertoire’ were to be extended to add more illnesses. A drawback to this though may be a patient who comes in with one of the 13 illnesses but still insists on seeing an MD.2. Cut down on physicians – this would be a direct result of the above.
More patients would be treated by NPs and less MD time available would also result in less walk ins fixed by doctors. This is because work will now flow according to actual need rather than to balance workload as triage coordinators often do. That basic problem arises from the fact that NPs are completely utilized and MDs are under-utilized.3.
Another sure shot way to cut down on time is to overlap the time a patient spends waiting to be seen by an NP/MD with the time spent in retrieving his records. There is a straight 13-14 minutes which goes in just record retrieval and administrative work. Patient details should be confirmed electronically through a identification card used by the university or by a patient card issued by the UHS on a first visit which is used as an identification card on subsequent visits. This may cost a moderate but not unaffordable sum of money.
An alternate to this entire strategy above could also include going back to the pre-triage system. This at the moment actually adds about 7.5 minutes to the entire process. If we can correctly distribute the tome of the nurses and the doctors as described above there really is no need for the triage system.
Each person first directly goes to a nurse (we have more nurses and more nurse time available) and the nurses can either treat the patient or refer to a doctor. This excludes patients who ask for a doctor on arrival itself. The trial system, however, should only be eliminated if the survey above reveals that say 50-60% of the total diagnosis are for the 13 illnesses or for illnesses which are included after the nurses repertoire has been expanded.Yes, walk ins are certainly an added problem in the triage system.
There are a multifold of reasons for this :1. It leads to an imbalance of patient distribution between doctors. Some doctors may be preferred and patients queue up to see them. The figures presented clearly show that some doctors like Recife have 48% patients of the patients they examine asked for them specifically and have a 25 day wait period to first appointment while others like Cristobal have 2 days.
2. It leads to an increased amount of time that both the patients asking for the specific MD and those just waiting for any MD spend in the system just because by volume there are now more people waiting to see not a specific MD but just an MD in the system.3. It often leads to a patient who could easily have been diagnosed and treated by a NP waiting to see an MD, so again, not only increasing the time he spends in the system but increasing it for others and creating an imbalance that can be easily avoided.
Q3. To improve the overall “service quality” of the clinic, what actions and steps would you recommend to Ms. Angell? Discuss the potential benefits and drawbacks of your recommendations.Ans3.
Patients were often found to complain about UHS that they found it to be cold, inefficient and impersonal, this was pre-triage but even after the triage system was implemented the system seems to be only marginally better off. To summarize, some of the steps that Ms. Angell can take:1. Decrease the amount of time that a patient spends waiting to get some sort of medical (not clerical) attention.
Instead he/she would feel more reassured if he were spending time being diagnosed or at least feeling that he is being paid attention. Some ways to do this have already been described above. Benefits of this would be that the patient would feel more comfortable and waiting time would be reduced. But, for this to be done more clerical or NP staff would need to be hired, which will mean an extra cost.
2. An increased number of nurse practitioners should see patients and perhaps the medical records should include which NP/MD examined the patient on his/her last visit. Ideally, not necessarily the patient should be put in a queue to see the same NP or MD. This will help patients build a relationship or just a comfort level with the NPs rather than just the doctors.
Again, a potential drawback to this may be that bottlenecks may be created for certain NPs or MDs but the chances of this happening are minimal if this system were managed well with such queuing only being an ideal situation not a priority.3. Both doctors and students should be educated on what the vision and priority of the UHS is – to provide the best possible care to all patients, not provide an atmosphere reminiscent of the country doctor’s office. At the moment however patients were moving towards being specifically treated by an MD or a requested MD.
Pre-triage figures for this 41% and 195 and post-triage figures for the same were 48% and 24% respectively. However, this created bottlenecks and unevenly distributed workloads which was something which needed to be avoided.
Cite this Describe the problems of the walk-in clinic for which the new triage system was created to tackle?
Describe the problems of the walk-in clinic for which the new triage system was created to tackle?. (2017, Dec 24). Retrieved from https://graduateway.com/describe-problems-walk-clinic-new-triage-system-created-tackle-essay/