"Is that for here or to go?" Drive-Through Pediatric Vaccine Clinic as a Novel Approach during a Global Pandemic.

OBJECTIVE: Routine childhood vaccination and well-child visits are essential for pediatric patients' preventative and public healthcare services. The COVID-19 pandemic had an immediate and significant decline in well-child visits and vaccine administration. A one-of-a-kind 'Drive-Through Vaccine Clinic' was established to improve the vaccination rate and alleviate parental anxiety about being exposed to COVID-19 infection. METHODS: Our initial focus was on children between 18 months - 4 years of age at the start of the pandemic, and then extended this to the back-to-school vaccines and the Influenza vaccines. RESULTS: The Drive-Through Immunization Station provided 745 vaccines to 415 patients between April and September, 2020. The median wait time involved from patient arrival to completion of vaccine administration was 5 minutes at the Drive-Through location. Patient and parent feedback was positive. The addition of the Drive-Through Clinic helped to significantly increase the total number of vaccines administered compared to the previous year. CONCLUSION: In a global pandemic, innovative ideas to increase access to preventive healthcare should be a priority. In the future, this method of non-traditional vaccine administration, will allow for improved outreach efforts to underserved populations in our communities, and better disaster preparedness.

Utilizing process improvement strategies to generate clinic templates and improve patient flow in pediatric otolaryngology.

OBJECTIVES: To examine outcomes from process improvement strategies aimed to: 1) develop computer generated physician clinic templates using captured and historic clinical data, and, 2) introduce said new template designs while maintaining historic daily patient volumes. METHODS: An Institutional Review Board approved retrospective review of time stamped data collection in a tertiary facility pediatric otolaryngology clinic. RESULTS: A discrete-event simulation was built from timestamps associated with clinic interaction milestones. The data were analyzed to develop standard clinic templates with the goal to reduce patient overall visit length by 10%. A total of 12,052 clinic visits were analyzed, 8,045 before (avg. of 62.9 visits/day) and 4,007 after (avg. of 65.7 visits/day) template standardization. The change led to a 10.5% (5.5 min, p < 0.001) decrease in total clinic visit time from 52.3 ± 25.9 min to 46.8 ± 25.0 min. This data extrapolated over a year is estimated to save 1,567 clinic hours. Secondarily, it was found that patient experience was not affected as a result of this change. CONCLUSION: Discrete-event simulation, using the principles of process improvement, is effective in guiding clinic operational redesign. This quality improvement project decreased the average length of clinic visit by 10% with no impact on historic high clinic volumes. Patient flow can improve in high volume pediatric otolaryngology practices by using process improvement strategies and discrete-event simulations to create standardized provider templates. Theoretically, this strategy can lead to improved patient and physician experiences along with an increase in patient visits over time.

Process improvement strategy to implement an outpatient surgery center efficiency model in an academic inpatient setting.

OBJECTIVES: By utilizing process improvement methodology, we aim to: 1) create an ambulatory surgical efficiency model (SEM) confined to an inpatient setting, and 2) reduce patient wait time and improve patient flow within the operating room. METHODS: A prospective cohort of all otolaryngology cases performed from May 2016 to October 2017 at a tertiary, academic, pediatric hospital. Intraoperative timestamps were collected to determine turnover times. Time to procedure was collected from clinic visit to the day of operation. RESULTS: A total of 5955 patients were enrolled. 3393 cases were performed prior to the implementation of SEM and 2562 after. Of the 2562 cases, 819 were deemed appropriate for the SEM. Prior to the SEM, the average number of working days between the clinic visit and operating room (WD) was 31.1 days (95% CI 30.7-31.4). After the SEM, the WD for non-SEM cases was 30.0 days (95% CI 29.7-30.2), and the WD for SEM cases was 14.4 days (95% CI 14.2-14.6). The average turnover time was significantly less for SEM cases at 11.4 min (95% CI 10.7-12.2) vs. non-SEM cases at 24.4 min (95% CI 23.9-25.0) (p < 0.0001). CONCLUSION: Process improvement methodology is effective in improving perioperative patient flow. This quality improvement project decreased the average time from diagnosis to surgical procedure, as well as decreased the average turnover time between cases. Patient flow can improve with a high-volume SEM within an inpatient hospital operating room setting. This strategy can be instrumental in improving patient care by providing increased access to the operating room.

Use of Simulation Software in Optimizing PACU Operations and Promoting Evidence-Based Practice Guidelines.

PURPOSE: As health care service costs continue to rise, hospitals are looking for innovative solutions to reduce financial burden while maintaining, and even advancing, quality of care. The objective of this study was to reduce costly delays in perioperative operations. DESIGN: Quality improvement project using lean methodology. METHODS: Discrete event simulation was used to evaluate multiple scenarios for improving the flow of patients through the Ambulatory Surgery Center's recovery unit. Bottlenecks were identified to safely minimize service delays and enhance the patient's experience. FINDINGS: Applying the Theory of Constraints, postanesthesia care unit recovery time was identified as the system constraint. An average 5- to 8-minute reduction in recovery time would reduce OR delays by more than 20%. Improvement efforts were focused on application of evidence-based practice. CONCLUSIONS: Simulation established a safe and cost-effective environment for exploring tests of change and optimizing the physical design and operations of an expansion hospital site.