Christine Xu, David Chen, Daniel R Jones, Kareem Moussa, Michele C Lim
Relocation to a new clinic was associated with clinically meaningful reductions in imaging wait time and total visit duration. Although specific operational changes were not independently evaluated, expanded imaging resources and workflow optimization may have contributed to improved clinic efficiency and patient throughput.
PURPOSE: To evaluate the association of clinic workflow changes following relocation to a new eye institute with imaging wait time and total patient visit duration.
PATIENTS AND METHODS: This retrospective cohort study included 1815 patients seen in glaucoma and retina clinics at an academic ophthalmology practice during 3-month periods before and after relocation. Electronic health record metadata were used to measure visit components. Operational changes included increased imaging staff, additional imaging devices, expanded clinic space, and implementation of a decentralized workflow with an optical coherence tomography (OCT) device embedded within a glaucoma clinic pod. Primary outcomes were imaging wait time and total visit duration before and after relocation. Associations between patient demographic and clinical variables and clinic flow metrics were also evaluated.
RESULTS: For combined glaucoma and retina services, median imaging wait time decreased from 21 minutes (IQR, 13-33; n=1259) before relocation to 11 minutes (IQR, 6-19; n=1244) afterward. The median paired difference was -11.0 minutes (IQR, -21 to 0; n=958; p<0.0001). Median total visit duration decreased from 102 minutes (IQR, 74-133; n=1687) to 91 minutes (IQR, 67-118; n=1763), with a median paired difference of -9.0 minutes (IQR, -45 to 20; n=1647; p<0.0001). Multivariable quantile regression analysis demonstrated a significant 48.3-minute reduction in total visit duration at the 25th percentile (p=0.0038). During the post-relocation period, decentralized glaucoma OCT workflow was associated with shorter median visit duration than centralized workflow (75 vs 94 minutes; p<0.0001). Age, sex, race and ethnicity, primary language, body mass index, and visual field testing were not significantly associated with outcomes.
CONCLUSION: Relocation to a new clinic was associated with clinically meaningful reductions in imaging wait time and total visit duration. Although specific operational changes were not independently evaluated, expanded imaging resources and workflow optimization may have contributed to improved clinic efficiency and patient throughput.