Feature: Automated queue management in a healthcare setting
Melton Health is part of Djerriwarrh Health Services, a provider of public health care services to the Melton and Moorabool shires, located approximately 45km to the west of Melbourne. Djerriwarrh Health Services’ mission is to help people in our community to better health and well-being. It does this by providing an integrated range of health services including primary, ambulatory, acute and aged care.
Services are provided from five main campuses: Melton Community Health Centre (primary care), Melton East Community Health Centre (primary care), Melton Health (ambulatory care), Bacchus Marsh & Melton Regional Hospital (acute care) and Grant Lodge (aged care). The organisation employs over 650 staff and has a total organisational budget of over $40m.
Melton Health opened in February 2006 and is a purpose-built Victorian government-funded Super Clinic providing same-day hospital and ambulatory care services to the rapidly expanding communities in the Melton and Moorabool shires. One of the key objectives of Super Clinics was to utilise new and innovative technology to deliver services in a more efficient and effective manner.
The Melton Health implementation team believed that improving the time and way people were queued was an important contributor to patient satisfaction. The implementation team identified an opportunity to use an automated queuing system to reduce the number of reception counters and waiting areas required, reducing capital and recurrent operating costs. While automated queuing systems were becoming more widely used throughout a wide range of client service industries, it became evident that no one had previously attempted to integrate the technology with a health service’s patient administration system (PAS).
The objectives of installing an automated queuing system integrated with the health services’ patient management system were to:
- reduce the need for patients to wait in queues at reception counters;
- provide instruction to patients on which waiting area to attend and how to get there, using technology;
- allow clinicians to see the names and length of wait of each patient waiting for their clinic from the computer screen located in their consultation room;
- provide a mechanism for clinicians within their consulting room to “call up” patients from the waiting room;
- automate the collection of arrival times, consultation commencement times and consultation completion times without having to manually enter the data into the PAS;
- alert managers when waiting times exceed predetermined thresholds; and
- allow monitoring of performance targets against performance indicators.
Planning for the integrated automated queuing system was overseen by an information technology committee, established as part of the implementation team of the three Super Clinics. A local information technology team was also established for Melton Health, focusing on the technical integration of the queuing system and patient management system using the information technology infrastructure in place at Djerriwarrh Health Services.
Initially, the efforts of the team focused on ensuring that the integration was technically possible and then scoping the project. As part of scoping the project, a realistic Gantt chart of activities was developed as well as flow charts outlining the expected patient flow throughout the various services. Upon acceptance of the project scope and budget by the information technology committee, the project was then implemented by the local information technology team.
In order to achieve the project’s objectives, Qmatic was selected as the automated queuing system and was integrated with iSoft’s (now CSC) i.PM patient management system using HL7 messaging through third-party HL7 messaging software called HL7 Connect. The integration and implementation of the project was achieved within the prescribed timelines and prior to the clinic opening.
From a patient’s perspective, the implementation of the automated queuing system means that upon entering the clinic, the patient scans a barcode at the top of their appointment notification letter at one of two self-service kiosks located near the front door. As the patient scans the letter their name is added to a list of patients waiting on the clinician’s computer screen in their consulting room. The patient is also automatically recorded as “arrived” in the patient management system. The kiosk issues an appointment number ticket and provides information on which waiting area – designated by a colour coding system – to attend.
When the clinician is ready to see the patient, they click a button on their computer screen which initiates both an audible and visual call up of the patient’s ticket number over the speaker system and waiting room television. The call up includes information on what entry door to use to enter the consulting area. The call up of the patient by the clinician also automatically initiates recording of the consultation commencement time. Calling up the next patient by the clinician initiates recording of the conclusion time of the consultation for the previous patient in the patient management system.
The implementation of the automated queuing system has reduced the need for patients having to use reception services, freeing up the reception for general inquiries and other customer service matters. Clinicians are able to monitor the number and length of wait of patients. Managers are automatically alerted of the need to problem-solve any excessive wait issues, against predefined thresholds, as they occur in real time.
While other healthcare organisations may use a “deli” system to call up patients, a fully integrated queuing system in the patient management system provides much more capacity to automate a complex array of clinic services (sometimes over 40 individual clinics running at once) and utilise the technology for record-keeping purposes as well as monitoring waiting times.
While there is no pre-implementation statistical information to compare the impact of the automated queuing system, post-implementation data collected confirms that less than one in 10 patients need to use the reception services and the average wait time from the time of scanning the letter at the self-service kiosk to the time that the clinician calls up the patient from the waiting area is no greater than 10 minutes.
A patient survey confirms that 72 per cent of patients perceived that they did not have to wait at all for their service while 98 per cent perceived that they waited less than 15 minutes. A survey of staff also suggests that staff perceived the computerised systems at Melton Health as a major strength in the model of care provided.
In relation to the design of the building, the automated queuing system reduced the number of reception counters required from four to three, as well as reducing the waiting area floor space by approximately 25per cent. It is estimated that the initiative reduced the building cost by about $800,000 (at 2006 building rates).
Keeping abreast of technological advances can be challenging, particularly when the technology is new. The outcome of implementing an automated queuing system at Melton Health has been positive both from the health service’s point of view as well as the patients’.
About the authors
David Grace is a registered nurse and the deputy chief executive of Djerriwarrh Health Services. In 2000 he was awarded the Public Service Medal for his contribution to health management. Angela Mayhew is the manager of the Health Information Department of Djerriwarrh Health Services.
David Grace PSM
Dip of App Sc (Nursing), BA of Hlth Sc (Nursing), MHon (Nursing), RN
BA Sc (Health Information Management)
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