A. S. Manjunathan1, S. Gupta1, S. S. Yang1, C. E. Kein1, A. A. Mazurek1, R. M. Reddy1 1University Of Michigan,Ann Arbor, MI, USA
Introduction: Although many institutions have focused on improving patient-centered care, there has been little study on how preoperative clinic workflows affect patients. We hypothesized that a streamlined clinic workflow is associated with decreased burden of cost and time on patients in a surgical oncology clinic.
Methods: A retrospective chart review was performed for all adult patients who underwent surgical treatment for esophageal cancer within a Thoracic Surgery clinic and pancreatic, liver, or biliary cancer within a Hepatopancreaticobiliary (HPB) clinic in a single tertiary care center in 2016. The clinics varied in preoperative visit and test scheduling practices, with the Thoracic clinic focused on minimizing patient visits prior to surgery. Data collected included the number of clinic visits, testing visits, and phone calls during the patient’s workup. Distance traveled to appointments, cost of travel, and total time burden were estimated. Visits, phone calls, travel costs, and time spent were compared using t-tests.
Results: We compared 70 esophageal cancer and 60 HPB cancer patients, who were demographically similar in age (63.3 +/- 10.7 vs. 63.5 +/- 11.6, respectively; p=0.93). Patients undergoing workup in the Thoracic Surgery clinic required significantly fewer preoperative appointments compared to patients in the HPB clinic (2.4 +/- 0.7 vs. 4.0 +/- 1.9, respectively; p<0.00001). 45 of 60 patients in the HPB cohort had an extra visit the day prior to surgery for lab work, whereas the Thoracic clinic incorporated this into the patient’s last clinic visit. There was no significant difference in the average number of phone calls received, which we used as an indicator of clinic resource utilization, in the Thoracic versus HPB clinic (7.4 +/- 4.9 vs. 6.4 +/- 6.2, respectively; p=0.31). The mean distance travelled in miles by patients in the Thoracic versus HPB clinic was not significantly different (105.9 +/- 109.2 vs. 93.5 +/- 59.3, respectively; p=0.44); however, the estimated total cost burden due to gas was significantly lower for Thoracic clinic patients than HPB clinic patients ($44.0 +/- 43.0 vs. $73.6 +/- 63.0, respectively; p=0.0029). There was also a significant reduction in time burden for patients in the Thoracic versus HPB clinic (11.3hrs +/- 6.7 vs. 18.5hrs +/- 11.7, respectively; p<0.00001).
Conclusion: This study demonstrated that with a streamlined preoperative workflow that consolidates necessary tests into fewer visits, one clinic has reduced cost and time burden to patients without a significant increase in clinic resource use. Furthermore, the true burden to patients is likely far greater, given potential lost wages and unnecessary stress. These findings should encourage all surgical clinics to evaluate their own preoperative workflow to identify areas in which care can be streamlined in an effort to improve patient-centered care.