2009 COA Award Recipient
3^rd Prize Award

IMPROVING WAITING TIMES AND RESOURCE UTILIZATION IN THE CAST CLINIC

Peter Lewkonia, M.D.
University of Calgary
Calgary, AB  

P. Duffy
T. Rohleder 

Purpose:
We characterize the use of resources in a cast clinic using discrete-event simulation modeling.  Our goal was to reduce the overall patient time for appointments to less than 60 minutes. 

Methods:
Patient visits were divided into discrete events including check-in, X-ray, orthopaedic technologist, trainee and surgeon time.  Patient process times were recorded and analyzed to construct a computer model of the clinic on which potential modifications could be tested.  Changes included altering appointment scheduling practices and modifying X-ray resources.  Demographic information and diagnosis were also collected. 

Results:
Average appointment time was 78 minutes.  Surprisingly, we were not able to correlate patient diagnosis, age, or visit number to clinic time.  Changes in patient interval time and block size, as well as increasing X-ray resources and avoiding loading patients in the early part of the clinic all improved patient flow significantly.  Application of all three changes in the model reduced average clinic times by over 50%. 

Conclusion:
Patients spend longer than one hour in the cast clinic. Based on a computer model, we have found that simple changes in scheduling may result in significant improvements in these times.  Unexpectedly, we were unable to predict patient process times based on patient attributes.