Average Wait Research Articles

Abstract 31: Let Me Be Your Guide: The Impact of Stroke Navigators on Post-Acute Stroke Follow Up

Introduction: Stroke patients often require complex post-discharge management in an outpatient setting. At this Comprehensive Stroke Center, stroke patients are to receive a 30-day, 90 day, and 1 year follow up with the stroke clinic. Post-acute follow up appointments are typically established after discharge, leading to scheduling delays for the 30-day appointment, patients lost to follow up, or no showing to appointments. Stroke Navigators are an emerging role that can bridge the gap between acute and post-acute care settings and integral to ensuring stroke patients receive optimal follow up care. Methods: In 2022, a Stroke Navigator was added to the care team and collaborated with the Stroke Clinic to project volume of clinic slots needed for ischemic and TIA hospital discharges. The Stroke Navigator implemented follow up scheduling with patient/family prior to discharge and emphasized the importance of the 30-day appointment. Pre and postintervention data was then collected and analyzed from Q2 2022 to Q1 2023 regarding timeliness of scheduling, appointment type, and rate of no shows for all ischemic stroke/TIA patients. Results: The pre-intervention scheduling process resulted in an average wait time of 19 days to schedule appointments. Post intervention, no wait time identified as appointments were scheduled prior to discharge. Pre-intervention data on 30-day appointments showed only 23% of patients were scheduled and attended their provider visit, while post-intervention data showed 60% (Table 1). The clinic no show rate went from 19%, down to 10% in the post intervention phase. Conclusion: The Stroke Navigator has made a significant impact on the number of patients with 30-day visits, eliminated the wait time for appointments due to scheduling prior to discharge, and decreased the no show rate for patients at 30 days. Further financial analysis will be critical to validate the impact of a Stroke Navigator, as they are critical to closing the gap in post-acute care.

Evaluation and Optimization of Diabetic Retinopathy Screenings for Uninsured Latinx Patients in a Resource-Limited Student-Run Free Clinic.

Diabetic retinopathy (DR) is a sight-threatening condition that causes progressive retina damage. Student-run free clinics represent a valuable opportunity to provide DR screenings to high-risk populations. We characterized the patient population, evaluated the performance, and conducted a needs assessment of DR screenings at the University of California, San Diego Student-Run Ophthalmology Free Clinic, which provides care to predominantly uninsured, Latino patients. Retrospective chart review was conducted of all patients seen at the free clinic since 2019 with a diagnosis of type II diabetes. Date and outcome of all DR-related screenings or visits from 2015 onward, demographics information, and DR risk factors such as A1c and insulin dependence were recorded. Predictors of diabetic retinopathy and frequency of DR screenings for each patient were analyzed using multiple logistic regression, t-test for equality of means, and Pearson's correlation. Of 179 uninsured diabetic patients receiving care at the free clinic, 71% were female and average age was 59. 83% had hypertension, 93% had hyperlipidemia, and 79% had metabolic syndrome. Prevalence of non-proliferative DR was 34% and that of proliferative DR was 15% in diabetic patients. The free clinic capacity in recent years plateaued at just under 50% of patients seen for DR screening or visit per year, though average wait time was over 2 years between visits. Patients with higher no-show rates had less frequent DR screenings. Chronic kidney disease and poor glycemic control were the strongest predictors of DR. The student-run free ophthalmology clinic has been effective in providing screening and follow-up care for DR patients. Creation of a protocol to identify which patients are at highest risk of DR and should be seen more urgently, addressing no-shows, and implementation of a tele-retina program are potential avenues for improving clinic efficiency in a resource-limited setting for vulnerable populations.

Effectiveness of Wait Time Targets and Patient Satisfaction Feedback in Decreasing Wait Times for Prescription Services in an Outpatient Pharmacy.

Long wait times for prescription services at the Outpatient Pharmacy of the Dr. OEN SOLO BARU Hospital in Indonesia have led to high numbers of complaints. In response, to decrease these wait times, the hospital undertook an intervention to determine wait time targets and provide feedback on patient satisfaction to personnel in the Outpatient Pharmacy. To measure the impact of providing wait time targets and patient satisfaction feedback to pharmacists in terms of decreasing wait times for prescription services at the Outpatient Pharmacy. This quasi-experimental research study had a single-group interrupted time-series design. Data on wait times and patient satisfaction were collected from "waiting patients". The study participants were 35 employees (6 pharmacists and 29 technicians), and the intervention entailed provision of wait time targets and patient satisfaction feedback to the participants every week for 5 consecutive weeks. The wait times for prescription services decreased by 11.13 minutes (17%) for compounded prescriptions and by 12.70 minutes (37%) for noncompounded prescriptions. There was a significant change in average wait time for both compounded and noncompounded prescription services from week 0 to week 4 (p < 0.001). There was also a significant change in patient satisfaction from week 0 to week 4 (p < 0.001). Patient satisfaction increased significantly in conjunction with the decrease in wait times for prescription services. The intervention of providing wait time targets and feedback on patient satisfaction to pharmacists helped to reduce wait times for prescription services.

Evaluating the network adequacy of vision care services for children in Arizona: A cross sectional study.

Vision challenges are among the most prevalent disabling conditions in childhood, affecting up to 28% of school-age children. These issues can impact the development, learning, and literacy skills of affected children. While vision problems are correctable with timely diagnosis and treatment, insufficient networks can impede children's access to comprehensive, and high-quality care. The study aims to determine where pediatric vision care network adequacy exists in the state of Arizona and where there are gaps in receiving vision care for children. This cross-sectional study assessed the adequacy of pediatric vision care networks in Arizona through a "secret shopper" phone survey. Calls were made to practices that accept Arizona's Medicaid program, Arizona Health Care Cost Containment System (AHCCCS) and/or commercial insurance. Providers were contacted following a standardized script to schedule routine appointments on behalf of 10 and 3-year-old patients enrolled in either Medicaid or commercial health insurance plans. The study examined various components of children's access to vision care services, including the reliability of provider directory information, time until the next available appointment, bilingual service offerings, ages served, region of practice and types of care available. A total of 556 practices in Arizona were evaluated through simulations as patients on AHCCCS, and 510 practices were assessed through simulations as patients with commercial health insurance plans. The average wait time for the next available appointment was 13 days for both insurance types. Alarmingly, up to 74% of vision care practices in Arizona do not serve children covered by AHCCCS. Furthermore, only 41% provide services to children 5 years and younger. Our findings underscore the need to improve access to vision care services for children in Arizona, especially racial/ethnic minorities, low-income groups, and rural residents.

Potential demand for and access to medication abortion among North Carolina college students

Objective To estimate demand for medication abortion (MAB) among North Carolina (NC) college students and describe access to nearest clinics offering MAB to each campus. Methods We calculated demand using 2019-2020 campus demographics and NC abortion statistics. We used a mystery client technique to gather MAB cost and appointment wait times at the closest clinics and calculated travel distances and times. Results We estimated that 2,517 NC students seek MAB annually. Twenty-one clinics were closest to NC’s 111 colleges and universities, including five in neighboring states. Mean cost was $450, with an average wait time of six days to appointment. The average round-trip travel distance was 58 miles and time to the nearest clinic was 84 min by car. Conclusions Many NC college students likely obtain MAB every year and face high costs, long wait times and distances to care, which has likely worsened after the overturning of Roe v. Wade.

Tackling efficiency in a high demand orthopaedic clinic.

Surgical outpatient clinics continuously face challenges in delivering efficient and effective care. An expanding population and chronic staff shortages makes sustainability critical. The primary objective of this study was to identify modifiable factors contributing to longer wait times in an orthopaedic outpatient clinic. A single-centre prospective observational cohort study was conducted at Western Australia's state trauma centre. Over a four-week period, clinicians completed forms identifying delays in clinic, and clinic numbers were captured through an electronic booking system. Data was analysed using SPSS v27. Face-to-face (FTF) and telehealth (TH) clinic volumes grew by 18.9% and 361.1% respectively between 2018 and 2022. For the study period, 754 forms were completed for attending clinic patients. This captured 42.4% and 96.8% of FTF and TH actual attendance. The average wait time for doctor consultation was 63.9 min. Wait times significantly reduced when x-rays were performed prior to clinic (P < 0.001), and when an unaccredited registrar held the on-call phone (P < 0.001). Trauma clinics ran overtime in 95% of cases compared to elective clinics in which 25% ran overtime. The golden staffing ratio was one doctor for 13 patients. TH experienced few delays related to technological fault. This study demonstrates that clinic volume continues to rise. It highlights the demand for adequate staffing and identifies several modifiable factors that influence clinic efficiency. It demonstrates the growth of TH as an alternative modality for outpatient surgical services and its potential for future expansion.

"Calculation of Average Waiting Time from Diagnosis Till Surgical Intervention for Minor and Day Case General Surgical Procedures"

"Calculation of Average Waiting Time from Diagnosis Till Surgical Intervention for Minor and Day Case General Surgical Procedures"

Queuing Simulation Modelling for the Interview Process at the Technical and Vocational Education and Training (TVET) Institutions

Queuing simulation modelling is one of the indicators used to determine the effectiveness of procedures that incorporate queuing simulation modelling. As a result, this paper utilised queueing theory throughout the Technical and Vocational Education and Training (TVET) institution’s interview process in Malaysia. The simulation reveals that the queuing simulation comprises a single queue connecting to multiple servers. Each interview stage involves serving more than two (2) candidates concurrently. As a result, the model used in this case study is a multiple-server model, in which more than two (2) servers concurrently serve a single waiting line in parallel. The purpose of queuing simulation modelling is to quantify operational characteristics such as the average number of candidates in the line, the average number of candidates in the system, and the average wait time for candidates in the line and the system. The results indicate that all steps are well-organised and completed within the time constraints associated with each stage. Identifying individuals who combine necessary skills with the ability to overcome challenges, manage stress, deal with ambiguity, work effectively in a team, and demonstrate resourcefulness will benefit the organisation in the short and long term. Therefore, the organisation developed a procedure in which job candidates are immersed in unusual settings to elicit the most useful information about their fitness, personality, critical thinking ability, creativity, and interpersonal skills.

Assessing Access to Trauma-Informed Outpatient Mental Health Services for Adolescents: A Mystery Shopper Study.

The authors aimed to examine how access to trauma-informed mental health services in safety-net health centers varies by insurance type and race-ethnicity of the care seeker. In this mystery shopper study, three women (White, Latina, and Black voice actresses) called community mental health centers (CMHCs) and federally qualified health centers (FQHCs) (N=229) in Cook County, Illinois, posing as mothers requesting a mental health appointment for their traumatized adolescent child. Each health center was called twice-once in the spring and once in the summer of 2021-with alternating insurance types reported (Medicaid or private insurance). Ability to schedule an appointment, barriers to access, wait times, and availability of trauma-specific treatment were assessed. Callers could schedule an appointment in only 17% (N=78 of 451) of contacts. Reasons for appointment denial varied by organization type: the primary reasons for denial were capacity constraints (67%) at CMHCs and administrative requirements to switch to in-network primary care providers (62%) at FQHCs. Insurance and organization type did not predict successful appointment scheduling. Non-White callers were significantly less likely (incidence rate ratio=1.18) to be offered an appointment than the White caller (p=0.019). The average wait time was 12 days; CMHCs had significantly shorter wait times than FQHCs (p=0.019). Only 38% of schedulers reported that their health center offered trauma-informed therapy. Fewer than one in five contacts resulted in a mental health appointment, and an apparent bias against non-White callers raises concern that racial discrimination may occur during scheduling. For equitable access to care, antidiscrimination policies should be implemented.

Improving Patient Access and Provider Availability in Classical Hematology: The Development of an Advanced Practice Provider Led Virtual Anemia Consult Clinic

Background: Classical hematology entails the diagnosis and treatment of many complex disease processes. The growing volume of referrals to classical hematology is challenged by staff hematology provider shortages. Our institutional goal for new patient access is to be seen within 7 days of the scheduling request. In Q2 of 2022, the leadership team identified the average wait time for a hematology consult was greater than 3 weeks and anemia consults comprised over 2/3 of these consultation requests. To address this need, a taskforce was developed to utilize trained classical hematology advanced practice providers (APPs) to see anemia consults virtually for initial work up and management. To optimize APP consult utilization, a centralized virtual anemia consult clinic (VACC) was developed to address patient access issues and improve staff physician consult availability for more complex hematologic diseases. VACC strived to provide greater access to local metropolitan areas as well as reaching those in-state several hours away, breaking down barriers in transportation and access. Methods: In September 2022, a centralized VACC was launched and staffed by hematology APPs to provide availability for patients with an anemia diagnosis. APPs performed triage, assessment, diagnosis, and provided treatment for anemia diagnoses. VACC is staffed Monday-Friday with 5 new consults per day (40 minutes for each consult) for a total of 25 anemia consults per week. Common diagnoses such as iron deficiency and nutritional anemias were seen in VACC (Figure 1A). A staff hematologist and APPs huddled once weekly to discuss complex patients to triage, diagnose, and treat appropriately. Results: APPs in VACC saw a total of 610 in-state virtual consults between September 2022 and May 2023. The median wait for a virtual anemia consult was 4 days. APPs were able to see virtual anemia consults in 31 Ohio counties, reaching counties at the northern most part of the state, to the southern most tip (Figure 1B). This provided patients with flexibility to be evaluated at home without driving hours for a consult. Of patients seen, 82% were female, 17.9% male and 0.1% non-binary. Racial demographics included 29.8% black, 1.7% Asian, 0.7% American Indian, 4.4% multiracial, and 60.7% white patients. Classical hematology APP revenue increased 276%. VACC slot utilization during this time averaged 91%. Overall classical hematology access for physicians and APPs improved from its peak of 20 days just before VACC started, to 8 days in May 2023. The majority of patients (73%) seen for initial consultation were incorporated into the APP practice for follow up visits and further treatment, increasing slot utilization and productivity for hematology APP practice. Conclusions: Collaboration between hematology physicians and hematology APPs within our institute led to an initiative increasing patient access for hematology diagnoses through the development of an APP staffed VACC. VACC led to a decrease in days wait for patients to be seen with an anemia diagnosis and provided increased consult slots to our staff hematologists to see more complex hematologic cases. Barriers such as transportation and limited scheduling options were removed through the option of scheduling anemia consults into VACC centralized clinic. Weekly huddles between staff hematologist and APPs led to collaborative relationships, mentoring, education, and increased expertise of colleagues to better serve patients and provide quality care in assessment, diagnosis, and treatment of patients with anemia diagnoses. Recommendations: APP led virtual consult clinics in classical hematology clinics are valuable tools to increase patient access and APP productivity, improve scheduling workflows, and decrease barriers related to patient inconveniences and social barriers. Hematology physician shortages call for an increase in education and collaboration with hematology APPs to execute comprehensive care to hematology patients. Future efforts for this clinic will focus on patient outcomes, addressing further social barriers identified to hematology patients, and consideration of expanding diagnoses seen in virtual consult clinic, such as thrombocytopenia, to expand timely access to care.

Increasing Access to Kidney Transplantation for Black and Asian Patients Through Modification of the Current A2 to B Allocation Policy.

The rate of A2 to B incompatible (ABO-i) kidney transplant continues to be low despite measures in the new Kidney Allocation System (KAS) to facilitate such transplants. This paper shows how the number of ABO-i transplants could increase if KAS policies were utilized to their fullest extent through a boost in ABO-i priority points. Predicting transplant outcomes using the Kidney Pancreas Simulated Allocation Model (KPSAM), preloaded with national data of 2010. We used this simulation to compare KAS to a new intervention in which priority equal to cPRA=100 has been given to blood type B candidate who are willing to accept an A blood type organ. The number of African American recipients increased by 375 (from 35% of recipient population to 38.7%), the number of blood type B African Americans increased by 65 (from 8% of recipient population to 9%), and the number of blood type B African Americans receiving blood type A kidneys increased by 49 (from 2% of recipient population to 2.5%). The same change occurred for Asians, particularly blood type B Asians (from 0.54% of the recipient population to 0.7%). Average wait time notably decreased by 27 days for blood type B African Americans. In the proposed scenario, 263 blood type B African Americans received blood type A organ (2.5% of recipient population) while only 181 (1.1%) of such transplants were performed in 2021. These results signify a considerable opportunity loss of ABO-i transplants for African American patients. If this policy was universally adopted, we would expect to see an overall increase of A2 to B transplantation, but in reality, not all centers perform ABOi transplantation. Thus, adopting this policy would incentivize other centers to perform more subtyping of A-type kidneys, and it would increase access to organs for blood type B Asian and African Americans in centers where ABOi transplantation already takes place.

Performance Evaluation of Priority-based Scheduling in Hybrid VANETs for Different Criteria Weights Using AHP-AHP and AHP-TOPSIS

Multi-Criteria Decision Making (MCDM) approaches have been developed to support a wider range of application areas. For example, channel allocation, among the vehicles in infrastructure-based/hybrid Vehicular Ad hoc NETworks (VANETs), is done by exploiting MCDMs to minimize the waiting time and maximize the request service rate by the Road Side Unit (RSU). The Analytic Hierarchy Process (AHP) developed by Saaty, however, has gained enormous popularity and been used all over the world since its invention in 1977. AHP is capable of prior weight calculation of individual criteria using Criteria Preference Matrix (CPM) and rank computation of alternatives as well. Another MCDM technique, termed Technique for Order of Preference by Similarity to Ideal Solution (TOPSIS), was created by Hwang and Yoon in 1981. It is a ranking technique that requires inputs of the weights of the criteria. This paper aims to analyze the impact on ranks of various alternatives for different CPMs using the AHP-AHP method and the AHP-TOPSIS method. For both cases weights of criteria have been calculated using AHP before rank computation. In addition to that, this paper deals with the performance evaluation of infrastructure-based VANETs for priority-based channel allocation using the AHP-AHP and the AHP-TOPSIS method in terms of Request Service Rate and Average Waiting Time for various CPMs. It is observed that AHP-TOPSIS performs better in terms of Request Service Rate with the increasing alternatives. Furthermore, the AHP-AHP method shows frequent rank change while increasing the number of alternatives for various CPMs.

Patient sex, racial and ethnic disparities in emergency department triage: A multi-site retrospective study

ObjectivesThere is limited evidence on sex, racial, and ethnic disparities in Emergency Department (ED) triage across diverse settings. We evaluated differences in the assignment of Emergency Severity Index (ESI) by patient sex and race/ethnicity, accounting for age, clinical factors, and ED operating conditions. MethodsWe conducted a multi-site retrospective study of adult patients presenting to high-volume EDs from January 2019–February 2020. Patient-level data were obtained and analyzed from three EDs (academic, metropolitan community, and rural community) affiliated with a large health system in the Southeastern United States. For the study outcome, ESI levels were grouped into three categories: 1–2 (highest acuity), 3, and 4–5 (lowest acuity). Multinomial logistic regression was used to compare ESI categories by patient race/ethnicity and sex jointly (referent = White males), adjusted for patient age, insurance status, ED arrival mode, chief complaint category, comorbidity score, time of day, day of week, and average ED wait time. ResultsWe identified 186,840 eligible ED visits with 56,417 from the academic ED, 69,698 from the metropolitan community ED, and 60,725 from the rural community ED. Patient cohorts between EDs varied by patient age, race/ethnicity, and insurance status. The majority of patients were assigned ESI 3 in the academic and metropolitan community EDs (61% and 62%, respectively) whereas 47% were assigned ESI 3 in the rural community ED. In adjusted analyses, White females were less likely to be assigned ESI 1–2 compared to White males although both groups were roughly comparable in the assignment of ESI 4–5. Non-White and Hispanic females were generally least likely to be assigned ESI 1–2 in all EDs. Interactions between ED wait time and race/ethnicity-sex were not statistically significant. ConclusionsThis retrospective study of adult ED patients revealed sex and race/ethnicity-based differences in ESI assignment, after accounting for age, clinical factors, and ED operating conditions. These disparities persisted across three different large EDs, highlighting the need for ongoing research to address inequities in ED triage decision-making and associated patient-centered outcomes.

Effectiveness of Manchester triage flow model regarding patients’ waiting time in Bahria international hospital Lahore, Pakistan

The triage system is meant to be implemented in all (Accidental &amp; Emergency Departments) so as to help and determine the relative priority of individual patient needs. Emergency patients are to be given immediate treatment, while those with non-acute symptoms may have to wait longer (Lucke et al., 2021). Assessment process during the triage need to be balanced with the extent of patient flow, as expanding the assessment process during triage may slow down the patient flow and may lead to delay in emergency service provision (Lucke et al., 2021).Through the use of computer-generated reports, archival data records for two months from the ED of the Bahria International Hospital in Lahore, Pakistan to assess the effectiveness of patients triage flow model. The results of this quantitative study showed that the patient flow model had a considerable temporal effect. Including 16 females, 25 were male and 25% average waiting was more than 240 mints. The ability to decrease patient wait times while enhancing patients quality of care and health outcomes is one of the social change implications. A quantitative study would produce data that would assist medical staff by shortening the wait times for patients.

Reducing time toxicity: Impact of a fast-track infusion pathway on overall wait-times and patient satisfaction at a large safety-net health system.

386 Background: Time toxicity is an emerging concept focusing on the impact of cancer care beyond traditionally measured outcomes: the time spent towards receiving care. Although the inherent complexity of cancer care can pose a challenge to improve time toxicity, addressing system and workflow inefficiencies through process improvement is an effective mitigation strategy. Here we present the impact of a fast-track infusion pathway on the wait-times and patient satisfaction at a large safety-net system. Methods: Parkland Health (PH) is the safety-net system for Dallas County, TX. The PH oncology infusion center supports cancer disciplines and other subspecialties. Factors such as timely patient arrivals, preference for coupled visits and same-day lab draws, and heterogeneity of treatments (medicine specialties vs. oncology) significantly impact wait times. In July 2022, a multidisciplinary team was formed to reduce wait times at the infusion center, including members who had previously participated in the ASCO Quality Training Program (QTP). This report is focused on developing a fast-track pathway for patients with injections or &lt;30-minute infusions. Patients with coupled appointments and same-day lab draws were eligible for fast-track. Wait times were calculated from the time patients were checked in at the front desk to the first medication administered. A dedicated team (RN and MA) and separate waiting areas/infusion bays were designated for fast-track patients. Fast-track patients were surveyed for satisfaction. Results: Baseline infusion volume for the 3 months prior to fast-track implementation was 106 patients per day with average wait time of 167 minutes. In the seven-month period after fast-track implementation, average daily fast-track and main infusion center combined volume was 115. The first PDSA cycle was focused on improving workflows and communication with pharmacy. In the second PDSA cycle, the fast-track infusions were moved to another area to infusion chairs to better patient flow. In May 2023, average volumes and wait times for fast-track and main infusion were 28/80 minutes and 87/107 minutes, respectively. This represents a 40% decrease in wait time for fast-track and 36% for main infusion. In our survey, 89% of fast-track patients reported their wait time to be shorter and 92% rated their experience good or excellent. Conclusions: Implementing and optimizing a separate process for short treatments reduced the wait times for both the short infusions (fast-track) as well as long infusions (main infusion) without a need for additional staff, infusion chairs, or space. The observed decrease in main infusion wait-time is likely the result of decongestion of their process by moving some of the volume to fast-track. We hope to further decrease our wait-times through additional PDSA cycles and leveraging process improvement methodology.

Intravenous hydration station in the chemotherapy infusion unit: A feasibility pilot study to improve efficiency, capacity, and wait times.

44 Background: Intravenous hydration (IVH) is frequently administered to oncology patients in outpatient chemotherapy infusion units. High demand for IVH often leads to capacity restraints in the chemotherapy infusion unit, negatively impacting the availability of infusion chairs for cancer-directed therapy, causing long wait times and patient dissatisfaction. This feasibility study aimed to expand the capacity for IVH and chemotherapy at a regional site of an academic medical center, through a dedicated hydration station outside of the conventional infusion chairs. Methods: A mobile space adjacent to a nurses’ station, within the chemotherapy infusion unit, was designated and converted to accommodate two patients simultaneously for IVH. Privacy screens separated this area from the rest of the infusion unit. Patients were directly scheduled into hydration station chairs. One nurse provided patient monitoring within the hydration station. The hydration rate was standardized to 1 liter per hour, subject to change at the discretion of treating physicians. Outcomes collected included the number of patients treated, total hours of hydration, wait times, and patient satisfaction, which was ascertained by a survey administered during February 2023 of the pilot phase. Results: Over a six-month period from December 2022 through May 2023, a total of 784 patients received IVH in the hydration station. This equates to 11 hours of IVH per day, and a cumulative total of 1,590 hours over the course of six months. The average wait time from check-in to starting IVH was 7 minutes. During the same period, the average wait time for chemotherapy was halved to 16 minutes. Among 28 patients who completed the satisfaction survey and had previously received IVH in a conventional infusion chair, 24 (86%) reported that the hydration station was either better or equivalent to their prior hydration experience. 23 (82%) patients reported a shorter or similar wait time compared to the conventional process. Overall, 84% were satisfied with their experience. Importantly, no patient safety issues were reported during the six-month period. Conclusions: IVH can be safely and effectively administered outside the conventional infusion chair, resulting in decreased wait times and high patient satisfaction. This IVH model increased the capacity for cancer-directed therapy in the chemotherapy infusion unit, with no reported safety issues. It is being standardized and implemented across other infusion units across our institution.

Characteristics of Emergency Department Visits Made by Individuals With Sickle Cell Disease in the U.S., 1999–2020

Individuals living with sickle cell disease experience high levels of morbidity that result in frequent utilization of the emergency department. The objective of this study was to provide updated national estimates of emergency department utilization associated with sickle cell disease in the U.S. Data from the National Hospital Ambulatory Medical Care Survey for the years 1999-2020 were analyzed. Complex survey analysis was utilized to produce national estimates overall and by patient age groups. On average, approximately 222,612 emergency department visits occurred annually among individuals with sickle cell disease, a nearly 13% increase from prior estimates. The annual volume of emergency department visits steadily increased over time, and pain remains the most common patient-cited reason for visiting the emergency department. Patient-reported pain levels for individuals with sickle cell disease were high, with 64% of visits associated with severe pain and 21% associated with moderate pain. Public insurance sources continue to cover most visits, with Medicaid paying for 60% of visits and Medicare paying for 12% of visits. The average time spent in the emergency department increased from previous estimates by about an hour, rising to approximately 6 hours. The average wait time to see a provider was 53 minutes. Utilization of the emergency department by individuals living with sickle cell disease remains high, especially for pain. With more than half of patients with sickle cell disease reporting severe pain levels, emergency department staff should be prepared to assess and treat sickle cell disease-related pain following evidence-based guidelines and recommendations. The findings of this study can help improve care in this population.

Implementation of a dedicated cascade testing clinic for patients at risk for hereditary cancer syndromes.

Cascade testing, the site-specific genetic testing of relatives within families with an inherited condition, is underutilized. Long wait times for appointments in specialty genetics clinics are a known barrier to genetic testing access. In our cancer genetics, New Patient Clinic (NPC), the long wait time for an appointment (on average 5 months for routine referrals), was identified by both providers and patients as a barrier to uptake of cascade testing. Timely testing of at-risk relatives is essential to maximize the benefits of cascade testing and reduce cancer morbidity and mortality. Our objective was to improve access via implementation of a different clinical model that designated appointments for patients seeking cascade testing. A secondary goal was to improve use of genetic counselor time. We implemented a dedicated Cascade Testing Clinic (CTC) with an expedited triaging and unique scheduling model to decrease patient wait time to appointment and optimize clinician time. We report on the process and outcomes here. Between October 2016 and February 2020, the average wait time between referral date and first scheduled appointment date was 46 days for the CTC compared to 144 days for the NPC (p < 0.0001). No-show/cancelation/rescheduling rate was 11.7% in the CTC compared to 29.7% in the NPC (p < 0.0001). Genetic counselors saw approximately twice as many patients per half-day clinic in the CTC compared to the NPC (p < 0.00001). Modifications to clinic staffing and appointment times were made based on provider feedback. Implementation of a dedicated clinic specifically for patients seeking cascade testing significantly shortened wait times for this population, reduced patient drop-off, and improved clinician efficiency. The relatively straightforward indications and generally uncomplicated medical histories made this an ideal population for expedited appointments.

An exploration of healthcare use in older people waiting for and receiving Australian community-based aged care services.

Home care packages (HCPs) facilitate older individuals to remain at home, with longer HCP wait times associated with increased mortality risk. We analyze healthcare cost data pre- and post-HCP access to inform hypotheses around the effects of healthcare use and mortality risk. Regression models were used to assess the impact of delayed HCP access on healthcare costs and to compare costs whilst waiting and in the 6- and 12 month periods post-HCP access for 16 629 older adults. Average wait time for a HCP was 89.7 days (SD = 125.6) during the study period. Wait-time length had no impact on any healthcare cost category or time period. However, total per day healthcare costs were higher in the 6 and 12 months post-receipt of a HCP (AU$61.5, AU$63, respectively) compared with those in the time waiting for a HCP (AU$48.1). Inpatient care accounted for a higher proportion of total healthcare costs post-HCP (AU$45.1, AU$46.3, respectively) compared with in the wait time (AU$30.6), whilst spending on medical services and pharmaceuticals reduced slightly in the 6 month (AU$7.1, AU$6.3) and 12 month (AU$7.2, AU$6.3) post-HCP periods compared with in the wait time (AU$7.9, AU$7.1). Increased spending post-HCP on inpatient care or non-health support afforded by HCPs may offer protective effects for mortality and risk of admission to aged care. Further research should explore the association between delayed access to inpatient care for geriatric syndromes and mortality to inform recommendations on extensions to residential care outreach services into the community to improve the timely identification of the need for inpatient care. Geriatr Gerontol Int 2023; 23: 899-905.

Cross-Layer Optimization on Different Data Rates for Efficient Performance in Wireless Sensor Network

The traditional protocols used in wireless sensor networks adhere to stringent layering approaches, which decreases the performance of the quality of service (Quality of Service) metrics. As per specifications 802.15.4, wireless sensor networks are inexpensive and energy efficient. It is essential for evaluating the performance of WSNs. Researchers have looked into the fundamental aspects of a single physical layer and the medium access control (MAC) layer protocol using methodologies calculated using several mathematical models or experimental approaches, respectively. In this research, we offer an improved cross-layer analytical model that utilises a thorough combining and interacting of a Markov chain model of the MAC layer's propagation with a model of the PHY layer's propagation. This combination and interaction are described in detail. Various Quality of Service (quality of service) statistics are presented and evaluated, and a cross-layer effectiveness degradation study is conducted under different inputs of multi-parameter vectors. Other parameters, such as Average Wait Time, Reliability, Failure Probability, and Throughput, have been estimated from the simulation results and contrasted with standardised models. The cross-layer model provides a more thorough performance study with various cross-layer parameter sets, some of which comprise distance, power transmission, and offered loads, among other things.