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A User-Friendly Excel Simulation for Scheduling in Primary Care Practices

In: Computers and Technology

Submitted By valentinamoral
Words 1031
Pages 5
El propósito de este estudio fue proporcionar una herramienta de simulación de Excel asequible y sencilla para su uso, en prácticas de atención primaria, para gestionar la programación del calendario de citas. Adaptándose a múltiples tipos de pacientes y tiempos de servicio estocásticos para las etapas de la enfermera y las etapas de los proveedores , en el flujo de pacientes.
La herramienta Excel se puede modificar sencillamente para distintas prácticas incorporando sus propios datos y necesidades. En este caso de estudio, se cuantifica el impacto de la flexibilidad de las enfermeras y/o proveedores para satisfacer las demandas de pacientes para múltiples proveedores.
Desarrollo
Las prácticas de atención primaria juegan un papel vital en la prestación de asistencia en salud, ya que proporcionan prevención de la salud, consejería, educación, diagnóstico y tratamiento. La combinación de corto tiempo en la atención y largo tiempo de espera es lo que más perjudica en la satisfacción del paciente. Para evitar esta situación, se necesita una política eficaz de programación de citas. Sin embargo, la atención primaria se enfrenta a un problema de programación compleja debido a la variedad de las condiciones del paciente, la mezcla de tipos de citas (físicas, seguimientos, y urgente), y la incertidumbre en el tiempo de servicio de los pacientes con proveedores y enfermeras/auxiliares, dando como resultado un horario muy variable e impredecible para ellos.
Con el fin de mejorar la programación en la asistencia sanitaria, muchos estudios utilizan la simulación, ya que puede dar cabida a sistemas de colas complejas y a factores ambientales. Pero, por desgracia, estas herramientas de simulación no son de asequibles para las pequeñas prácticas de atención primaria. De acuerdo con la Encuesta Nacional de Atención Médica Ambulatoria 2010, cerca de 32% son visitas individuales a médicos. Para las prácticas pequeñas, puede ser efectivo usar algo ampliamente disponible, como Excel.
Por efecto, el objetivo de este estudio es proporcionar una herramienta de simulación de Excel asequible y sencilla para programadores, para la gestión de programas de horas, que puedan acomodar múltiples pasos en el proceso de flujo de pacientes: el tiempo de espera en el vestíbulo, el tiempo de servicio con la enfermera, el tiempo de espera en la sala de exámenes, el tiempo de servicio con el proveedor, y el tiempo total del paciente en la práctica. Además, permite diferenciar por tres tipos de pacientes que categorizan diversas condiciones y tipos de citas típicamente vistos en las prácticas. A su vez modificable, para incluir más recursos humanos, tipos de pacientes y medidas de rendimiento.
En este caso de estudio, utilizan la herramienta Excel para comparar el rendimiento dedicado versus flexible de enfermeras, basándose en datos empíricos y los horarios del estudio anterior, Oh et al. (2013). Ahí se construyó una cronología del flujo de pacientes para identificar los factores que causaban la gran variabilidad horaria y propusieron un clasificador de pacientes, basados en el tiempo que toma la atención, siendo estas citas: 1) HC (Alta complejidad), 2) LC (Baja complejidad) y 3) SD (Mismo día). Se encontró que un sistema de programación efectiva es la clave para mejorar la utilización de la práctica. Sin embargo, no es fácil para las pequeñas prácticas acceder a optimizaciones avanzadas o softwares de simulación por lo que se desarrolló este estudio.
La herramienta de simulación en Excel tiene las siguientes características:
• Un calendario con código de un color diferente para cada proveedor.
• Mediante la inclusión de un diagrama de Gantt con código de color basado en los tiempos de servicio promedio, la herramienta proporciona una ayuda visual para el planificador.
• Permite al planificador probar dinámicamente diferente mezcla de pacientes, combinaciones de secuencias y tiempos de partida en un formato que se asemeja a los calendarios del proveedor.
• La herramienta Excel permite al planificador poner escenarios aleatorios de entrada y calcular no sólo promedios, también percentiles claves de tiempo de espera, tiempo de inactividad y el tiempo total de la sesión.
La herramienta se puede utilizar de forma dinámica, como los horarios se vayan desarrollando con el tiempo. Un inconveniente, para el uso del tiempo real, es que las estimaciones precisas de la simulación estocástica dependen del número de escenarios, que a su vez, aumenta el tiempo de cálculo.
El modelo estocástico acomoda la coordinación de tiempos de servicio de la enfermera junto con el proveedor. Optimiza horario y secuencia de las citas para minimizar el tiempo de ocio del proveedor y el tiempo de espera del cliente.
En este estudio se consideraban tres casos o escenarios distintos: 1) Enfermeras dedicadas (cada una cuida un paciente, exclusivamente, de un panel de proveedores particulares). 2) Enfermeras flexibles (dos enfermeras comparten pacientes de dos quipo de proveedores). 3) Enfermeras flexibles y cruce (cada proveedor tiene su calendario pero puede elegir ver al paciente a la hora de la cita o cuando la etapa de la enfermera haya finalizado).
Los factores en la herramienta de simulación fueron los siguientes: pacientes clasificados en los tres tipos; tiempos de servicio estocásticos para enfermeras y proveedores; potencial de pacientes compartidos por enfermeras; no compartir citas entre proveedores.
Se crearon cinco hojas distintas en una planilla Excel siendo estas: Tiempo enfermera, tiempo proveedor, determinación, estocástico y horario. Todos los indicadores del flujo de los pacientes fueron calculados por algoritmos escritos en Visual Basic para aplicaciones (VBA) en Excel 2007. Estas prácticas pueden usar sus propias clasificaciones de pacientes, cambiando el código VBA para enlazar con los datos de las hojas de cálculo de la enfermera y de proveedores. También pueden utilizar distintos datos de entrada del tiempo de servicios en las hojas de cálculo de enfermera y proveedores.
Como resultado en los casos analizados, encontraron evidencia de que las enfermeras flexibles y cruces proporcionan beneficios significativos. Se demuestra que tener enfermeras flexibles mejora significativamente el tiempo de espera en el vestíbulo en un 37% pero, aumenta la espera en exámenes en un 12% si el proveedor no acepta cruces. Combinando esto hay un 2% de mejora entre tener enfermeras flexibles versus dedicadas. Pero el tener enfermeras flexibles más cruce genera una mejora de 16% en los tiempos, disminuyendo el tiempo de ocio de los proveedores y enfermeras en un 11%.

VALENTINA MORAL
22/10/15

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