Introduction & Objective :
Urology clinics have a relatively high number of procedures performed relative to other outpatient clinics. Incorporating these procedure visits into a standard office visit workflow can present a challenge due to differing demands on support staff and room/equipment turnover times. Our objective was to model the impact of a procedure-only-day compared with the traditional clinic day that has procedure visits interspersed with evaluation and management (E&M) visits in terms of staff utilization and patient wait times.
We used discrete event simulation to compare an experimental model (procedure-only-day plus two E&M days) compared to traditional model (three mixed days) per week. Resources included front desk, nursing/medical staff, and urologists. Percent utilization of resources, patient wait times, and total time through the system were compared between the two models. Inputs included type and duration of procedure, type and duration of E&M, intake times based on visit type, and turnover times. The distribution of visits was based on one month of three urologist schedules while the other inputs were tracked for an eight month period.
Over 1 month, 25% of visits were procedures with an even distribution of cystoscopy, cystoscopy with stent removal, and transrectal ultrasound-guided prostate biopsy. Mathematical distributions were fit to the inputs and used for modeling over a simulated 4-week period, with 10 repetitions. The mean wait time in the traditional model was 25.3 minutes (95% confidence interval (CI) 21.6, 28.9) compared to 22.9 (95% CI 19.6, 26.3) in the experimental model. The mean total time in the system was the same at 125 minutes. A sensitivity analysis varying the percent of procedure visits from 20-50% showed more favorable wait times in the experimental model with increasing percent procedures. There were no differences physician and nurse utilization between models.
Addition of a procedure-only clinic day does not appear to increase wait times, time through the system, or decrease physician or nursing utilization.