Improving health care quality in a pediatric ambulatory OR setting

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Primary and ambulatory care

Anthony Slonim, MD

The Center for Clinical Effectiveness at Children's National Medical Center has become familiar with the use of simulation software as a means of improving clinical operations and performing clinical research. Project management skills were incorporated with simulation tools such as Medmodel to improve patient throughput in an outpatient setting.

As health care quality expands its role beyond the walls of the acute care hospital, there is a need to transition the techniques that have relevance for an outpatient practice and to capitalize on new and innovative strategies that will be useful across outpatient service lines. By using a systems approach that focuses on design details, simulation can capture system interdependencies, account for variability in the system, and provide data on multiple performance measures with results that are quantitative and easy to understand.

We employed this technique to observe the effects of an additional operating room in our ambulatory environment. Our findings include the operational impact of adding the additional operating room on staffing and patient flow. We demonstrated an increase of 102 percent in patient volume and a reduction in average patient throughput time by 22 percent. It was noted that the average waiting time in the system also decreased significantly. If success in the improvement of quality for patients is to be achieved, opportunities to capitalize on the tools provided by other industries should be considered and studied. Simulation is one such tool that has the ability to assist clinicians and administrators in making decisions about their operations for complex systems.