scholarly journals Clinic Time Required for Remote and In-person Management of Cardiac Device Patients: Time and Motion Workflow Evaluation (Preprint)

JMIR Cardio ◽  
10.2196/27720 ◽  
2021 ◽  
Author(s):  
Amber Seiler ◽  
Eliana Biundo ◽  
Marco Di Bacco ◽  
Sarah Rosemas ◽  
Emmanuelle Nicolle ◽  
...  
Keyword(s):  
Cardiac Device ◽  
Time And Motion ◽  
Time Required

Clinic Time Required for Remote and In-person Management of Cardiac Device Patients: A Time and Motion Workflow Evaluation (Preprint)

2021 ◽  
Author(s):  
David Lanctin ◽  
Eliana Biundo ◽  
Marco Di Bacco ◽  
Sarah Rosemas ◽  
Emmanuelle Nicolle ◽  
...  
Keyword(s):  
Patient Management ◽  
Clinic Visit ◽  
Future Research ◽  
Staff Time ◽  
Cardiac Device ◽  
Cardiac Implantable Electronic Devices ◽  
Time And Motion ◽  
Number Of Patients ◽  
Time Requirements ◽  
Time Required

BACKGROUND The number of patients with cardiac implantable electronic devices (CIEDs) is growing, creating substantial workload for device clinics. OBJECTIVE This study aimed to characterize the workflow and quantify clinic staff time requirements to manage CIED patients. METHODS A time and motion workflow evaluation was performed in 11 US and European CIED clinics. Workflow tasks were repeatedly timed during one business week of observation at each clinic. Observations were inclusive of all device models/manufacturers present. Mean cumulative staff time required to review a Remote device transmission and for an In-person clinic visit were calculated, including all necessary clinical and administrative tasks. Annual staff time for follow-up of 1 CIED patient was modeled using CIED transmission volumes, clinical guidelines, and published literature. RESULTS A total of 276 in-person clinic visits and 2,173 remote monitoring activities were observed. Mean staff time required per remote transmission ranged from 9.4-13.5 minutes for therapeutic devices (pacemaker, ICD, CRT) and 11.3-12.9 mins for diagnostic devices (insertable cardiac monitors (ICMs)). Mean staff time per in-person visit ranged from 37.8-51.0 mins and 39.9-45.8 mins, for therapeutic devices and ICMs respectively. Including all remote and in-person follow-ups, the estimated annual time to manage one CIED patient ranged from 1.6-2.4 hours for therapeutic devices and 7.7-9.3 hours for ICMs. CONCLUSIONS CIED patient management workflow is complex and requires significant staff time. Understanding process steps and time requirements informs implementation of efficiency improvements, including remote solutions. Future research should examine the heterogeneity in patient management processes to identify the most efficient workflows.

Abstract 14046: An International Assessment of the Clinic Staff Time Required to Manage Cardiac Device Patients

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Eliana Biundo ◽  
Juliette Hennion ◽  
Sarah C Rosemas ◽  
David Lanctin ◽  
Emmanuelle Nicolle
Keyword(s):  
Electronic Device ◽  
Standard Of Care ◽  
Clinic Visit ◽  
Staff Time ◽  
Cardiac Device ◽  
Clinic Staff ◽  
Remote Transmission ◽  
Time And Motion ◽  
Time Required

Introduction: Remote monitoring (RM) of cardiac implantable electronic device (CIED) patients is guideline-recommended standard of care alongside in-office follow-up. However, overall workload requirements for device management are not well understood, which may hinder implementation of optimal follow-up strategies including remote solutions. This study sought to characterize processes and clinic staff time required for remote and in-person device follow-up of a CIED patient. Methods: A time and motion workflow evaluation was performed in 11 CIED clinics: 6 US; 5 Europe (UK, France, Germany). Participating clinics manage an average of 5,758 (range: 870-22,000) CIED patients. The duration of each CIED management task was repeatedly timed during 1 business week (5 days) of observation at each clinic. All device models/manufacturers were included. Mean staff time for a remote transmission and an in-person clinic visit were calculated, including clinical and administrative tasks. Annual staff time for follow-up of 1 CIED patient was modeled using data on CIED transmission volume, clinical guidelines, and published literature. Results: A total of 276 in-person clinic visits and 2,173 RM activities were observed. Mean staff time required per remote transmission ranged from 9.4-13.5 minutes for therapeutic devices, and 11.3-12.9 mins for insertable cardiac monitors (ICMs), while staff time per in-person visit ranged from 37.8-51.0 mins and 39.9-45.8 mins, respectively (Table 1). The estimated annual time to manage one therapeutic device patient was lower (1.6-2.4 hours) than an ICM patient (7.7-9.3 hours), due to fewer device follow-ups. Conclusions: RM allows for efficient and continuous care as a complement to in-person follow-up. However, overall CIED patient follow-up requires considerable staff time. These data should be considered in addressing barriers to RM adoption, such as challenges in workflow implementation and inconsistent reimbursement.

scholarly journals Time and Motion Study of Influenza Diagnostic Testing in a Community Pharmacy

2014 ◽  
Vol 5 (2) ◽  
Author(s):  
Donald Klepser ◽  
Allison Dering-Anderson ◽  
Jacqueline Morse ◽  
Michael Klepser ◽  
Stephanie Klepser ◽  
...  
Keyword(s):  
Community Pharmacy ◽  
Clinical Laboratory ◽  
Vital Signs ◽  
Pharmacy Practice ◽  
Original Research ◽  
Pharmacy Technician ◽  
Time And Motion Study ◽  
Time And Motion ◽  
Motion Study ◽  
Time Required

Background: It has been shown that use of rapid diagnostic tests (RDTs) is able to reduce costs and improve the prescribing practice of antivirals (i.e. oseltamivir) among patients with influenza-like illnesses (ILIs). Using existing Clinical Laboratory Improvement Amendment (CLIA)-waived RDTs and collaborative practice agreements, similar to those used to allow pharmacists to administer vaccines, it is possible for patients to seek point-of-care treatment for influenza or flu-like symptoms at a local pharmacy. Following a review of the patient's symptoms by a trained pharmacist, the qualified patient is offered an RDT to determine if the influenza virus is the cause of the symptoms. Based on the results of the RDT, the patient is provided with the appropriate treatment as defined by an approved practice agreement. Objective: The aim of this study was to evaluate the feasibility of incorporating an RDT for influenza into community pharmacy practice. Methods: This time and motion study was conducted at three community pharmacy locations, and a total of eight simulated patient visits were completed utilizing a standardized patient. In addition to determining a total time of the encounter, each simulation was divided into nine timed sub-categories. For data analysis, the time spent in each of the nine sub-categories was assigned to the pharmacist, pharmacy technician, or patient. Time and motion methodologies were used to estimate the total time required to provide the RDT service, to determine the amount of active time required of the pharmacist and pharmacy technician, and to evaluate the ability of the staff to provide the service within its existing workflow. Results: The average total time to complete the entire patient encounter for an influenza assessment utilizing an RDT was 35.5 minutes (± 3.1 minutes). On average, the pharmacist spent 9.4 minutes (± 3 minutes) per encounter or about 26.5% of the entire encounter. When the pharmacy technician collected the vital signs, the pharmacist-required time was reduced to 4.95 minutes (± 2.7 minutes), which was about a 48% reduction. Conclusions: The results indicate that an RDT program for influenza assessment required no more than a modest amount of pharmacist time and could be successfully incorporated into regular workflow with little to no disruption of other activities. As such, this approach to influenza management may be a feasible service for community pharmacies to offer patients. This was especially true if the pharmacy had well-trained technicians on staff that could support the service with collection of patient histories and vital signs.   Type: Original Research

scholarly journals Time Savings with Once-Monthly C.E.R.A.: A Time and Motion Study Conducted in 13 Haemodialysis Centres in Italy

2015 ◽  
Vol 40 (2) ◽  
pp. 173-179 ◽  
Author(s):  
Erwin De Cock ◽  
Persefoni Kritikou ◽  
Simona Ravera ◽  
Armando Filippini
Keyword(s):  
Health Care Professionals ◽  
Renal Anaemia ◽  
Time And Motion Study ◽  
Time And Motion ◽  
Motion Study ◽  
Receptor Activator ◽  
Anaemia Management ◽  
Time Savings ◽  
Time Required ◽  
Annual Time

Background: We sought to document the time required by health care professionals to administer erythropoiesis-stimulating agents (ESAs) and continuous erythropoiesis receptor activator (C.E.R.A.) in the management of renal anaemia. Methods: A Time and Motion study was conducted in 13 centres in Italy. The time spent on preparation, distribution, and injection for both ESA and C.E.R.A. groups was measured. A multilevel model was run to account for the centre-clustering effect. Results: The average number of ESA injections/patient/year was 89. The average uptake of C.E.R.A. was 26%. The average time per session was 1.54 min for ESA (95% CI 1.21-1.86) vs. 1.64 min for C.E.R.A. (95% CI 1.31-1.97). Estimated time/patient/year was 137 min for ESA and 20 min for C.E.R.A. Assuming a 100% uptake of C.E.R.A., annual time savings/centre would be 84% (194 h). Conclusions: Substantial annual time savings on frequent anaemia management-related tasks were found when a switchover was made from ESAs to C.E.R.A.

scholarly journals Clinic time required to manage cardiac implantable electronic device patients: a time and motion workflow evaluation

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
E Biundo ◽  
A Burke ◽  
S Rosemas ◽  
D Lanctin ◽  
E Nicolle
Keyword(s):  
Remote Monitoring ◽  
Electronic Device ◽  
Future Research ◽  
Funding Source ◽  
Staff Time ◽  
Private Company ◽  
Remote Transmission ◽  
Time And Motion ◽  
Time Required

Abstract Background The population with cardiac implantable electronic devices (CIEDs) is growing, creating workload for device clinics to manage these patients. However, the CIED follow-up workflow is poorly understood. This study sought to characterize the workflow and staff time for CIED patient management. Methods A time and motion workflow evaluation was performed in 6 U.S. CIED clinics, which manage an average of 4,217 patients. Each task involved in CIED management was repeatedly timed, including all manufacturers, during 1 business week at each clinic. Mean staff time for a remote transmission and an in-person visit were calculated, including all clinical and administrative (e.g: scheduling, documentation) activities related to the encounter. Annual staff time for follow-up of 1 patient was modeled using CIED transmission data for the 6 clinics, guidelines for CIED follow-up, and published literature. Results 124 clinic visits and 1,374 remote monitoring activities were observed. Staff time required per remote transmission ranged from 12.1–13.4 minutes (depending on the CIED type), and time per visit was 43.4–51.0 minutes. Including all remote and in-person follow-ups, the estimated total staff time per year to manage one pacemaker, ICD, CRT, and ICM patient was 2.3, 2.4, 2.4, and 9.3 hours, respectively (Table 1). Conclusion CIED clinic workflow is complex and requires significant staff time. Remote monitoring is an efficient complement to in-office visits, allowing for continuous follow-up of patients. Future research should examine heterogeneity in clinic processes to identify the most efficient workflow. Funding Acknowledgement Type of funding source: Private company. Main funding source(s): Medtronic

Observation of a Pharmacist-Conducted Group A Streptococcal Pharyngitis Point-of-Care Test: A Time and Motion Study

2017 ◽  
Vol 31 (3) ◽  
pp. 284-291 ◽  
Author(s):  
Carolyn E. Corn ◽  
Donald G. Klepser ◽  
Allison M. Dering-Anderson ◽  
Terrence G. Brown ◽  
Michael E. Klepser ◽  
...  
Keyword(s):  
Group A Streptococcus ◽  
Point Of Care ◽  
The United States ◽  
Streptococcal Pharyngitis ◽  
Point Of Care Test ◽  
Time And Motion ◽  
Need To Evaluate ◽  
Group A ◽  
Time Required ◽  
Encounter Time

Background: Acute pharyngitis is among the most common infectious diseases encountered in the United States, resulting in 13 million patient visits annually, with group A streptococcus (GAS) being a common causative pathogen. It is estimated that annual expenditures for the treatment of adult pharyngitis will exceed US$1.2 billion annually. This substantial projection reinforces the need to evaluate diagnosis and treatment of adult pharyngitis in nontraditional settings. Objective: The objective of this research is to quantify the amount of pharmacist time required to complete a point-of-care (POC) test for a patient presenting with pharyngitis symptoms. Methods: A standardized patient with pharyngitis symptoms visited 11 pharmacies for POC testing services for a total of 33 patient encounters. An observer was present at each encounter and recorded the total encounter time, divided into 9 categories. Pharmacists conducted POC testing in 1 of 2 ways: sequence 1—pharmacists performed all service-related tasks; sequence 2—both pharmacists and pharmacist interns performed service-related tasks. Results: The average time for completion of a POC test for GAS pharyngitis was 25.3 ± 4.8 minutes. The average pharmacist participation time per encounter was 12.7 ± 3.0 minutes (sequence 1), which decreased to 2.6 ± 1.1 minutes when pharmacist interns were involved in the testing (sequence 2). Conclusion: Although additional studies are required to further assess service feasibility, this study indicates that a GAS POC testing service could be implemented in a community pharmacy with limited disruption or change to workflow and staff.

Abstract 286: Clinic Time Required To Manage Cardiac Implantable Electronic Device Patients: A Time And Motion Workflow Evaluation

2020 ◽  
Vol 13 (Suppl_1) ◽  
Author(s):  
Eliana Biundo ◽  
Alan Burke ◽  
Sarah C Rosemas ◽  
David Lanctin ◽  
Emmanuelle Nicolle
Keyword(s):  
Remote Monitoring ◽  
Patient Management ◽  
Electronic Device ◽  
Future Research ◽  
Staff Time ◽  
Remote Transmission ◽  
Time And Motion ◽  
Number Of Patients ◽  
Time Required

Background: The number of patients with cardiac implantable electronic devices (CIEDs) is growing, creating workload for device clinics to manage this population. Remote monitoring of CIED patients is a guidelines-recommended method for optimizing treatment in CIED patients in combination with in-person follow-up. However, the specific steps involved in CIED management, as well as the HCP time required for these activities, are not well understood. The aim of this study was to quantify the clinic staff time requirements associated with the remote and in-person management of CIED patients. Methods: A time and motion workflow evaluation was performed in 6 U.S. CIED clinics. Participating clinics manage an average of 4,217 (range: 870-10,336) CIED patients. The duration of each task involved in CIED management was repeatedly timed, for all device models/manufacturers, during one business week (5 days) of observation at each clinic. Mean time for review of a remote transmission and for an in-person clinic visit were calculated, including all clinical and administrative (e.g., scheduling, documentation) activities related to the encounter. Annual staff time (inclusive of all clinical and administrative staff) for follow-up of 1 CIED patient was modeled using device transmission data for the 6 clinics, clinical guidelines for CIED follow-up, and published literature (Table 1). Results: During 6 total weeks of data collection, 124 in-person clinic visits and 1,374 remote transmission review activities were observed and measured. On average, the total staff time required per remote transmission ranged from 11.9-13.5 minutes (depending on the CIED type), and time per in-person visit ranged from 43.4-51.0 minutes. Including all remote and in-person follow-ups, the estimated total staff time per year to manage one Pacemaker, ICD, CRT, and ICM patient was 2.3, 2.4, 2.4, and 9.3 hours, respectively. Conclusion: CIED patient management workflow is complex and requires significant staff time in cardiac device clinics. Remote monitoring is an efficient complement for in-office visits, allowing for continuous follow-up of patients with reduced staff time required per device check. Future research should examine heterogeneity in patient management processes to identify the most efficient workflow.

Human resource (HR) costs of chemotherapy infusion reactions (IR) in community oncology

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 16013-16013
Author(s):  
J. Ogle ◽  
B. V. Fortner ◽  
K. Moore ◽  
L. Zhu ◽  
L. S. Schwartzberg
Keyword(s):  
Quality Care ◽  
Symptom Burden ◽  
Indirect Costs ◽  
Initial Assessment ◽  
Limiting Factor ◽  
Free Standing ◽  
Time And Motion ◽  
Community Oncology ◽  
Practice Efficiency ◽  
Time Required

16013 Background: Chemotherapy IR are the dose limiting factor for many agents and have clinical consequences ranging from patient symptom burden to death. No work has been done to describe the provider burden of chemotherapy IR. The purpose of this analysis was to describe the clinical interventions associated with mild and severe IR and estimate the associated HR costs. Methods: Staff from a single, free standing, community oncology practice were surveyed regarding involvement in the management of mild and severe chemotherapy IR using a modified time and motion survey to identify tasks required to manage CIR and the HR time required. Mild and severe chemotherapy IR HR events were created. Salary averages for each type of staff were used to estimate HR costs. Results: 39 staff participated in the survey and were 85% (n = 33) female, average age 44, with M = 7.6 years experience. 21 distinct tasks (e.g. initial assessment, patient monitoring, infusion stopped, notify physician) were identified representing the management of the mild and severe chemotherapy IR. 11 types of staff indicated routine participation in ≥ 1 IR related task. Total HR time was 188 and 194 minutes for mild and severe IR respectively, resulting in HR cost of $124 and $187. Conclusions: The above methodology will be used in an expanded analysis of 20 outpatient practices. Recent changes in cancer treatment reimbursement have resulted increased interest in practice efficiency and provider cost. Definitions for quality care should consider minimization of unnecessary direct and indirect costs and maximization of practice efficiency. Models such as the one described are needed to understand provider costs. Clinical processes and chemotherapy agents that reduce rates and severity of CIR should reduce HR burden related to CIR. [Table: see text] [Table: see text]

scholarly journals Living with breast cancer: Patients’ journey within the Greek National Health System

2015 ◽  
Vol 6 (4) ◽  
pp. 1-6
Author(s):  
Daphne Kaitelidou ◽  
Maria Kalogeropoulou ◽  
Theofanis Katostaras ◽  
Olympia Konstantakopoulou ◽  
Panagiotis Minogiannis ◽  
...  
Keyword(s):  
Breast Cancer ◽  
National Health System ◽  
Public Hospitals ◽  
Breast Cancer Patients ◽  
Record System ◽  
Time And Motion ◽  
Motion Study ◽  
Time Required ◽  
Study Participants ◽  
Patients Experience

Abstract Background: Process mapping (a patient-centred method) and recording the medical, nursing and administrative staff’s views involved in the provision of care help us understand patients’ experience regarding the constraints, delays and bottlenecks of healthcare service processes and identify areas of improvement. Patients and Methods: Time information and data were collected through time and motion study with regard to the path patients with breast cancer follow in two public hospitals (sample of 86 patients) and a semi-structured questionnaire was administered to medical, nursing and administrative staff (sample of 14 employees). Results: The amount of time required in total for the prescription process was increased up to seve7 times compared to the beneficial amount of time, and the longest delays in patients’ waiting time were observed with regard to the process of chemotherapy (more than 2 hours and 40 minutes, in some cases). About 92.3% of the staff of the two hospitals prioritized the malfunctioning of theCcentralIinformationSsystem as the most important factor and more than 75% of the study participants mentioned that several administrative and technical aspects have a negative and significant effect on the time required to prescribe the necessary medicines for the treatment of patients. Conclusions: The lack of understanding of the hospital’s processes and spatial infrastructure by most patients, the lack of an electronic patient record system and central information system are highlighted as the main issues that contribute decisively to the increase in the non-beneficial time that patients with breast cances have to spend nowadays in hospitals of the NHS in Greece.

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