Luci Leykum, M.D., M.B.A., M.Sc., is principal investigator of the two University of Texas System grants designed to improve patient care by streamlining complicated scheduling processes in clinics and hospitals.
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By Rosanne Fohn

Improving the quality of patient care by streamlining complicated scheduling processes in clinics and hospitals is the goal of two grants totaling $560,000 awarded recently to Luci Leykum, M.D., M.B.A., M.Sc., of the UT Health Science Center San Antonio and a number of her colleagues.

The three-year grants, awarded by The University of Texas System through its Systems Engineering in Healthcare Initiative, will fund collaboration between School of Medicine faculty members practicing at UT Medicine San Antonio, clinical partners and UT Austin’s Cockrell School of Engineering and McCombs School of Business.

UT Medicine San Antonio is the clinical practice of the School of Medicine at the University of Texas Health Science Center at San Antonio.

One grant for $280,000 will optimize the scheduling process of medical interns and residents — also called “housestaff” — in two primary care clinics where UT Medicine San Antonio provides care and clinical training.

The second grant, also for $280,000, is designed to better organize and streamline hospital processes for patients who need surgery.

The goal is to build systems engineering tools that improve processes in specific areas, such as the two primary care clinics and the surgery department of University Hospital, then make the tools available to other clinics within UT Medicine San Antonio and the Health Science Center community, to corresponding departments at other institutions within the UT System, said Dr. Leykum, associate professor of medicine and associate dean for clinical affairs, who is principal investigator of the grants.

Improving the delivery of primary care
Creating patient-centered models of primary care is a priority at UT Medicine San Antonio and the Health Science Center. Providing a “medical home” for patients is the recommended national model of care, as well as a major focus of health care reimbursement and policy reform.

“Part of providing a ‘medical home’ means that we improve access to care at the clinic; however, right now there are many challenges and variables in scheduling housestaff that affect how often residents and interns are present in the clinic and how many patients they can see. This, in turn, affects whether they are available to see their patients when their patients need to be seen,” Dr. Leykum said.

“For example, during their clinical training, housestaff must be scheduled for many different types of clinical experiences and responsibilities, and this affects how often they can be in the clinic. Another variable are the guidelines and expectations for each type of residency program that are set nationally by the Accrediting Council for Graduate Medical Education. We have to adjust the schedule when residents have a scheduling conflict or get sick and someone else has to work in their place. And we also have to maintain a certain ratio of supervising faculty members to housestaff when providing care. You can try to plan for many of these variables, but on a day-to-day basis, weaving them all together can be a challenge,” she said.

“Our intention is to create a systematic approach to scheduling housestaff that could be used by different residency programs at the Health Science Center and in other UT System institutions,” she said.

Streamlining processes for surgery
As the health care system moves toward paying for care based on patient outcomes instead of on a series of individual office visits and procedures, providers are working to coordinate care and improve efficiencies.

Dr. Leykum’s second grant focuses on improving outcomes for patients who need surgery. “Preparing a patient for surgery and post-operative care often involves coordination among several different kinds of physicians — surgeons, anesthesiologists, primary care physicians and potentially hospitalists — as well as nursing care and other services, such as physical therapy or occupational therapy, to provide the best outcome for patients,” Dr. Leykum explained.

“With the second grant we want to develop a process that will in essence create individualized patient plans so that each patient will receive the right pre-operative imaging and tests for their medical condition and procedure; fill out the appropriate paperwork; see their specialists in the right order; and coordinate care and information among all the providers,” Dr. Leykum said. “This will help improve efficiencies and eliminate bottlenecks for the patient, and should also reduce complication rates. Because this is such a complex issue, we are grateful to work closely with our colleagues at University Health System, including John Atchley, Noel Schafer and Carmen Sanchez.”

Colleagues
Other UT Medicine San Antonio physicians involved with the two grants are:

• Susan Noorily, M.D., clinical professor in the Department of Anesthesiology and director of University Hospital’s Peri-operative Medical Clinic;
  
  
• Jane O’Rorke, M.D., professor in the Department of Medicine’s Division of General Medicine and medical director of University Health System’s General Medicine Clinic;
  
  
• Ramin Skokati Poursani, M.D., associate professor/clinical in the Department of Family & Community Medicine. He is director of Inpatient Services and medical director of the Family Health Center at University Health System;
  
  
• Maureen Sheehan, M.D., associate professor of surgery and medical director of vascular surgery at the Medical Arts & Research Center, the clinical home of UT Medicine San Antonio; and
  
  
• Benjamin Wallisch, D.O., assistant professor of anesthesiology and medical director of University Health System's Operating Room Services.

Partnership
The two grants incorporate the expertise of the following systems engineering experts from UT Austin:

• Jonathan Bard, D.Sc., M.S., P.E., is a professor of operations research and industrial engineering in the Mechanical Engineering Department of the Cockrell School of Engineering. A world-recognized expert in heirarchical optimization, Dr. Bard has been doing work in personnel scheduling and real-time control in health care for the past 20 years.
  
  
• Leon S. Lasdon, Ph.D., is a professor in the Department of Information, Risk and Operations Management in the McCombs School of Business. Dr. Ladson was part of a five-person team presented the 2010 INFORMS Impact Prize for the development of the Microsoft Excel Solver, a widely used general-purpose optimization modeling system. He has worked on anesthesiologist scheduling at university hospitals and consulted with a number of organizations on employee scheduling.
  
  
• Douglas Morrice, Ph.D., is a professor in the Department of Information, Risk and Operations Management and director of the UT Supply Chain Management Center of Excellence in the McCombs School of Business. He will be involved with model design, development and analysis of the simulation and methodologies to improve process flow on the projects.