Modeling the impact of COVID-19 on retina clinic performance

ABSTRACT

Purpose: COVID-19, a highly contagious respiratory virus, presents unique challenges to the practice of ophthalmology as a high-volume, office-based specialty. In response to the COVID-19 pandemic, many operational changes were adopted in our ophthalmology clinic to enhance patient and provider safety, while maintaining necessary clinical operations. The aims of this study were two-fold to evaluate how measures adopted during the pandemic period affected the performance of the retina clinic and patient satisfaction;and to build a model from lessons learned for regulating future clinic operational performance, when the number of patients and providers returns to pre-pandemic levels. Methods: Timestamps were extracted from the electronic medical records of in-person retina encounters from March 15 to May 15, 2020 and compared with the same period in 2019 to assess patient flow through the clinical encounter. Patient satisfaction was evaluated by Press Ganey patient experience surveys returned by randomly selected outpatients. A discrete-events simulation was designed to model the clinic with COVID-era restrictions to assess operational performance under conditions of increasing patient and provider volumes. Results: Retina clinic volume declined by 62% during the COVID-19 health emergency. Average check-in-to-technician time declined by 79%, total visit length declined by 46%, and time in the provider phase of care declined by 53%. Interestingly, patient satisfaction with access nearly doubled during the COVID-period compared with the prior year (p < 0.0001), while satisfaction with overall care and safety remained high during both periods. A model incorporating COVID-related changes demonstrated that wait time before rooming reached levels similar to the pre-COVID era by 30 patients per provider in a 1- provider model and 25 patients-per-provider in a 2-provider model (p < 0.001). Capacity to maintain distancing between patients was exceeded only in the two 2-provider model above 25 patients-per-provider. Conclusions: Clinic throughput was optimized in response to the COVID-19 health emergency. Modeling these clinic changes can help plan for eventual volume increases in the setting of limits imposed in the COVID- era. The changes implemented enhanced the delivery of eye care and improved patients' sense of wellbeing, thus potentially becoming a new standard of care.