Modeling the impact of COVID-19 on Retina Clinic Performance

Abstract

Background: COVID-19, a highly contagious respiratory virus, presents unique challenges to ophthalmology practice as a high-volume, office-based specialty. In response to the COVID-19 pandemic, many operational changes were adopted in our ophthalmology clinic to enhance patient and provider safety while maintaining necessary clinical operations. The aim of this study was to evaluate how measures adopted during the pandemic period affected retina clinic performance and patient satisfaction, and to model future clinic flow to predict operational performance under conditions of increasing patient and provider volumes.

Methods: Clinic event timestamps and demographics were extracted from the electronic medical records of in-person retina encounters from March 15 to May 15, 2020 and compared with the same period in 2019 to assess patient flow through the clinical encounter. Patient satisfaction was evaluated by Press Ganey patient experience surveys obtained from randomly selected outpatient encounters. A discrete-events simulation was designed to model the clinic with COVID-era restrictions to assess operational performance under conditions of increasing patient and provider volumes.

Results: Retina clinic volume declined by 62 % during the COVID-19 health emergency. Average check-in-to-technician time declined 79 %, total visit length declined by 46 %, and time in the provider phase of care declined 53 %. Patient satisfaction regarding access nearly doubled during the COVID-period compared with the prior year (p < 0.0001), while satisfaction with overall care and safety remained high during both periods. A model incorporating COVID-related changes demonstrated that wait time before rooming reached levels similar to the pre-COVID era by 30 patients-per-provider in a 1-provider model and 25 patients-per-provider in a 2-provider model (p < 0.001). Capacity to maintain distancing between patients was exceeded only in the two 2-provider model above 25 patients-per-provider.

Conclusions: Clinic throughput was optimized in response to the COVID-19 health emergency. Modeling these clinic changes can help plan for eventual volume increases in the setting of limits imposed in the COVID-era.

Keywords: COVID-19; Discrete‐event simulation; Health Services Research; Outpatient; Patient flow.

Fig. 1

In-person and telehealth clinic encounters between March 15th and May 15th in 2019 and 2020. a In-person clinic encounters in 2019 and 2020. In 2019, 18 % of all in-person visits were retina encounters (n = 2,647) whereas in 2020 that proportion rose to 57 % (n = 1,015). b In-person and telemedicine encounters in 2020. In 2020, the retina service saw an increase in the proportion of telehealth visits relative to in-person encounters. Whereas in 2019 telehealth visits did not occur at all, during the peak pandemic period in Massachusetts, telehealth was being leveraged in over 50 % of all retina patient encounters on a weekly basis. Dashed vertical line represents the start of the Massachusetts stay-at-home order on March 16, 2020.

Fig. 2

Average in-person encounter task times. Average visit length declined by 46 % from 87 to 47 min. Check-in to provider time declined by 52 % from 69 to 33 min. Check-in to technician time declined by 79 % from 14 to 3 min. Check-in to image completion time declined by 31 % from 45 to 31 min.

Fig. 3

Simulated patient time in clinic. a Average total wait time before each patient was roomed in both the 1-provider and 2-provider models. b Average visit length in both the 1 provider, 2 technician and 2 provider, 3 technician models. Error bars present 95 % confidence intervals. (** p < 0.01).