1 Surrey Outpatient Care and Surgery Centre Kiosk Registration Modeling

2 2 The Surrey Outpatient Care and Surgery Centre  Scheduled to open in 2011, the new facility will improve the quality of care for Fraser Valley residents by providing a full range of scheduled outpatient services, including day surgery, diagnostic services and specialized health clinics  Clients will primarily be referred to the facility and will come and go in the same day  It is one of Fraser Health’s initiatives to decrease congestion at Surrey Memorial Hospital

3 3 Perinatal Clinics Antepartum Care at Home Nausea and Vomiting Outpatient Fetal Monitoring Diabetes in Pregnancy Surrey Prenatal Clinic Maternal Fetal Medicine Community Care Chronic Disease Management Enhanced Family Practice HIV / Aids / Hepatitis C Seniors Chronic Pain Med/Surg Clinics Neurology Preadmission Renal Vascular Access Urology Medical Day Care Outpatient Antibiotic Therapy (OPAT) Home IV Therapy Transfusion Clinic Phlebotomy Port-a-cath Access Other Infusions Anticoagulant Management Laboratory Respiratory Diagnostics Outpatient Surgical Services Orthopedics Gynaecology Minor General Surgery Plastics Ear, Nose and Throat (ENT) Urology (including Lithotripsy) Ambulatory Day Care Endoscopy Cystoscopy Colposcopy Minor Procedures Diagnostic Imaging General Radiography Screening and Diagnostic Mammography Ultrasound MRI, CT Nuclear Medicine Interventional Radiology Diagnostic Cardiology Bone Densitometry Fluoroscopy Med/Surg Clinics Cast-Ortho Plastics Breast Health Level 2 Level 3 Level 4 Layout and Service Mix: Education/Resource Centre Level 1 Lobby Total Estimates: Over 450,000 Annual Client Visits

4 4 Patient Journey – Seamless Process 1.Referral 2.Triage 3.Booked for an appointment 4.Register upon arrival 5.Receive clinical treatment and any other support services (i.e. lab, diagnostic imaging) 6.Inform of results 7.Discharge

5 5 Patient Registration All clients need to be registered upon arrival All scheduled clients (except surgical clients) Surgical & walk-in clients Successful Unsuccessful Clerk registration Proceed to Corresponding Clinic Waiting Area All patients Self check-in kiosks Much research was done on kiosk registration on how it could improve patient experience: Reduce wait time Provide a sense of control for patients Avoid recitation of demographic information First piloted at Langley Memorial Hospital

6 6 Problem Formulation  Patients would not be waiting in line too long for registration  Service targets:  99 % of clients wait < 5 minutes; with an average of 1 minute  99 % of the time, each kiosk queue would have < 5 people waiting; where the average number is < 1  How many kiosks will be required on each level to achieve targets  Complex process  More than 20 clinics  Multiple visit types  Project to process about 1,600 patients per day  Variability in system parameters (i.e. processing time, arrival time)  Uncertainly in behaviour (i.e. % usage, % flow to each floor)

7 7 Simulation Modeling Generate Clinic Arrivals Level 1 Level 2 Level 3 Level 4 Lobby

8 8 Model Demonstration

9 9 Scenario Runs to Support Decision Making  With the future in mind, we needed an upper limit estimate on the total number of kiosks data-drop that are required  To do this, we assumed that everyone will register at a kiosk  To further estimate kiosk requirements at each level, we then assumed that:  70% of the total volume will register at the lobby  70% of each clinical level volume will register at the corresponding clinic level  We also tested the scenario where both projected volumes and kiosks processing times were increased by 20% and 50%

10 Sample Results

11 Recommendations  Suggested final number of kiosk data drop and wiring at each level for the Care and Surgery Centre: Lobby:7 kiosks Level 1:1 kiosk Level 2:2 kiosks Level 3:3 kiosks Level 4:1 kiosk Total:14 kiosks

12 Other Considerations during Implementation  Lots of thoughts were also put into choosing the ideal location of kiosks given building constraints  Cluster  Visibility  Enough queuing space around  Kiosk capabilities  Variety of languages available  Print out of direction, way finding  Ensure patient confidentiality  Patient education and awareness  Kiosk attendance  Staff support and engagement

13 Ongoing Work to Opening & Beyond  Support to finalize the total number of kiosks to purchase  Update projected demands  Update clients’ arrival patterns  Remodel the percentage of kiosks usage  Based on more detailed demographic information  Based on type of visits (focus on recurring visits)  Extreme case: no kiosk usage  Continue to run specific scenarios upon requests  Look at the effects of kiosk down time  Support of kiosk early implementation

14 Conclusion  Operation research tool can be used to answer many questions and assist in the processing of decision making (evidence-based approach)  Very often, we are not necessarily finding the best solution from a pure operation efficiency viewpoint due to many other considerations around being patient centric  Yet, it helps to provide a data-driven and “visualization” tool to understand the different trade-off and help facilitate the discussion among health professions

15 Thank You Any Questions ?