Department of Ophthalmology: Out Patient Department

Department of
Ophthalmology: Out Patient

Department
Presented by: Group 4
Dolores, Rinah | Griffin, Natalie | Martinez, Mark |
Mendoza, Carlson | Solano, Felicia | Soon, Joyce
The Medical City
Department of Ophthalmology
Glaucom
a
Vision
Screen
Cataract
Red
eyes
Retinopathies
Department of Ophthalmology
Neuro-ophthalmology section
Vitreoretinal section
Glaucoma section
Uveitis section
Orbit section
Cornea section
Cataract section
Refractive section
Low-vision section
Plastic-lacrimal section
Pedia-ophthalmology section
1x
Administrati
ve nurse
1x
Unit
Clerk
4x
Ophthalmolo
gic
Technicians
Physicia
ns
Process Design and

Analysis
Service Clinic Requirements

1. Certificate of Indigence (barangay)
2. Valid Government ID
3. Social Case Study Report from DSWS
4. 1 month pay slip
Qualified? [ ]YES [ ] NO
TMC Prime Registration
Wait.
15mins 1hour
Visual acuity testing

Gross examination
Extra ocular
examination
Tonometry
Slit lamp
Fundoscopy
Physical Exam Resident Assessment

History taking
(Bottlenecking event)
Not yet seen by the

resident
5 20 mins
Resident Assessment
Need further
assessment?
15 30 mins
YES
Refer to
senior/consultant?
NO
Proceed to discharge
Service Process
Service Process
Production line approach
Assembled like a manufacturing line
Each person has specialized roles
Technology is spread out systematically
Clerk
Resident
Consultant
Re-arrangement of
equipment may cut
down unnecessary
waiting time
Behavioural approach in the OPD

Treat with empathy even if plenty
Start slow, finish strong
Clump the uncomfortable procedures
Give control to give comfort
Small gestures for big problems
Consultant
Poka-Yoke
Poka-Yoke
Waiting Line Analysis

and Simulation
OPD Clinic Hours

Monday to Friday 8:00AM to 4:00PM
Monday
Tuesday
Glaucoma Pediaand
Optha
Neurooptha
Wednesd Thursday Friday

ay
RetinaNew
New
Uveitis
patients,
patients,
external
orbitdisease
plasticand
lacrimal
refraction and low
vision
Main waiting Scenarios

1. Waiting to be called after triage
2. Interview with a medical clerk
3. Physical examination with a medical clerk
4. Referral to a resident
5. Referral to a senior/consultant
Factors affecting waiting time
1. New Patients ( called first and longer Hx and PE)

2. Holidays
3. Day of subspecialties
OPD Waiting time

Situation
Patients to be called by
clerks
History taking
Physical examination
Referral to a resident
Referral to a Consultant
Medications and home
instructions
Time
15 minutes to 1 hour
10 to 15 minutes
15 to 30 minutes
5 to 20 minutes
1 to 2 hours
10 to 30 minutes
OPD Waiting time

Patients without referral to
consultant
Patients with referral to
consultant
New patients without
referral to consultant
New patients with referral
to consultant
Total Waiting Time

55 minutes to 1 hour and
35 minutes
2 to 3 hours and 35 minutes
1 hour and 25 minutes to 2
hours and 5 minutes
2 hours and 10 moinutes to
3 hours and 5 minutes
OPD waiting time
Simple system model

Single channel layout
Single service phase
Infinite source of population
Poisson arrival pattern
OPD waiting time analysis

The
average utilization of the OPD

There is an average of 15 patients seen at the OPD per day. Patients arrive at the
OPD at a rate of 7 per hour. The OPD can service patients at the rate of 2 per hour.
= Arrival rate
= Service rate
p = = = 3.5 = 35%

The average number in the waiting line
Lq = = = 4.9 patients (4 patients)
The average number in the system

Ls = = = 1.4 (1 patient)
Average waiting time in line

Wq = = = 0.7 hour, or 42 minutes

Average waiting time in the system
Ws = = = 0.20 hour, or 12 minutes
Summary and Recommendations

The main problem is the prolonged waiting time due to
identified bottlenecks.
Time is increased by 50% due to referral to a consultant
Time may be reduced if residents assigned focus on the
OPD, and have proper time delineation.

Paying patients are given more importance to charity patients in
the OPD
Charity patients are still TMC patients thus the same standard of
care must be given
A backup consultants should be available for rescheduled patients
in need of specialist

Physical layout of the OPD tends to slow down the
process
Minor re-arrangement of the clinic may reduce travel
time and decrease congestion

Department of Ophthalmology: Out Patient Department

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Department of Ophthalmology: Out Patient Department

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Department of

Ophthalmology: Out Patient

The Medical City

Process Design and

Service Clinic Requirements

TMC Prime Registration

Visual acuity testing

Physical Exam Resident Assessment

Not yet seen by the

Behavioural approach in the OPD

Waiting Line Analysis

OPD Clinic Hours

Wednesd Thursday Friday

Main waiting Scenarios

Factors affecting waiting time

1. New Patients ( called first and longer Hx and PE)

OPD Waiting time

OPD Waiting time

Total Waiting Time

OPD waiting time

Simple system model

OPD waiting time analysis

average utilization of the OPD

OPD waiting time analysis

The average number in the system

Average waiting time in line

OPD waiting time analysis

Summary and Recommendations

Summary and Recommendations

Summary and Recommendations

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