IMPROVING OUTPATIENT-CLINIC STAFFING AND SCHEDULING WITH COMPUTER-SIMULATION

Patient now in an appointment-based, outpatient internal medicine clin ic involving multiple, sequential providers-registrar, triage nurse, p hysician, and discharger-was studied using computer simulation. Provid er task time distributions were obtained through a time-motion study a nd then input into the computer program, which simulated the clinic si tuation well. Time interval and sensitivity analyses yielded insights into staffing levels, appointment times, and clinic dynamics, A bottle neck provider was shown, and patient time in the clinic was related to the time of appointment and was slowed by having too many doctors in the clinic, Subsequent operational changes significantly decreased the average observed patient total time in clinic from 75.4 (SD 34.2) min utes to 57.1 (SD 30.2) minutes (P < .001, t test).