Lanes, clusters, lines of Sight: Modelling diagnostic eyecare clinics to improve patient flow

Lengthy waiting times for ophthalmology appointments in the UK National Health Service (NHS) increased further in the immediate aftermath of the Covid-19 pandemic, necessitating a different approach to triaging patients safely and at speed. Moorfields Eye Hospital NHS Trust therefore opened an additional diagnostic hub designed with a linear spatial layout and patient flow system, which is analyzed in this paper in comparison to an existing clinic. We integrate direct observations of patient flows, and an architectural layout analysis based on space syntax methods with queuing simulations from operations research and show that the two clinics operate differently and that both clinics have their advantages and disadvantages. The newly opened clinic with a lane system supports flows and coordination by line of sight between stations, which contrasts with a lack of sightlines in the existing clinic. The latter layout with clusters of stations compensates by enabling a more organic flow, es..., Fieldwork was undertaken in June and July 2021 in two outpatient clinics of Moorfield Eye Hospital NHS Trust, the Cayton Street clinic and the Hoxton Hub. Two main data sets were collected for each clinic: 1) an up-to-date floor plan of each clinic including the locations and types of all diagnostic equipment marked up, and 2) direct observations of glaucoma patient flows, recorded on tablets, including exact time stamps of entry and exit of the clinic as well as start and end times for all diagnostic tests.
For the observations, patients received a sticker with a study ID number at the reception desk, which was recorded by observers as an identifier. Over the course of ten days of observations, participant observers captured nine 4-hour shifts in the period from 8:30 to 17:00 in Hoxton, and six 4-hour day shifts and seven 3-hour evening shifts between 8:30 and 20:00 in Cayton Street. 14 patients at Cayton Street and 11 patients at Hoxton were shadowed for the entirety of their journey ..., , # Lanes, Clusters, Lines of Sight: Modelling diagnostic eyecare clinics to improve patient flow

[https://doi.org/10.5061/dryad.m0cfxppdj](https://doi.org/10.5061/dryad.m0cfxppdj)

## Description of the data and file structure

### **Data and analysis description**

To replicate our analysis, the following three pieces of work need to be completed: first, the spatial analysis of the layout; second, the analysis of the observational data on patient flows and timings; and third, the simulation of patient flow, which provides an indication of the ideal type and number of required machines. The following steps in each piece of work need to be completed.

### Spatial analysis

**1) Perform VGA and Step Depth Analysis**

Prepare a dxf file of a floor plan following the instructions in the Depthmap_VGA_HowToGuide.pdf, using the floor plan we have provided in the *VGA model* folder as an example.

Download DepthmapX to run Visibility Graph Analysis (VGA) and visual Step Depth (SD) from the same...

英国国民保健署（National Health Service, NHS）眼科门诊的冗长候诊时长在新冠疫情暴发后进一步攀升，亟需安全且高效的患者分诊新方案。为此，穆尔菲尔德眼科医院国民保健信托（Moorfields Eye Hospital NHS Trust）增设了一处采用线性空间布局与患者流线系统的诊断中心，本文将其与现有门诊开展对比分析。我们整合了患者流线的实地观测数据、基于空间句法（space syntax）的建筑布局分析，以及运筹学领域的排队模拟（queuing simulations）模型，结果显示两类门诊的运营模式存在显著差异，且各自具备优劣。新启用的通道式门诊依托站点间的视线通廊优化了患者流线与科室协同效率，而现有门诊则缺乏此类视线条件；后者采用站点集群布局，可通过更具灵活性的自然流线弥补这一不足……。实地调研于2021年6月至7月在穆尔菲尔德眼科医院国民保健信托的两家门诊开展，分别为凯顿街门诊（Cayton Street clinic）与霍克斯顿诊断中心（Hoxton Hub）。两家门诊均收集了两类核心数据集：1）各门诊的最新平面图，标注了所有诊断设备的位置与类型；2）基于平板设备记录的青光眼患者流线实地观测数据，包含患者进出门诊的精确时间戳，以及所有诊断检查项目的起止时间。

观测环节中，患者在前台领取带有研究编号的贴纸，观察者以此作为患者识别标识。本次观测为期十日，霍克斯顿门诊共完成9个4小时观测班次（时段为8:30至17:00）；凯顿街门诊则完成6个4小时日间班次与7个3小时晚间班次（时段为8:30至20:00）。凯顿街门诊共有14名患者、霍克斯顿门诊共有11名患者被全程跟随记录其完整就诊流程……

# 通道、集群与视线：建模眼科诊断门诊以优化患者流线
[https://doi.org/10.5061/dryad.m0cfxppdj](https://doi.org/10.5061/dryad.m0cfxppdj)

## 数据与文件结构说明
### **数据与分析说明**
若需复现本次分析工作，需完成三项核心任务：其一，布局空间分析；其二，患者流线与时序观测数据分析；其三，患者流线模拟，该模拟可用于确定所需诊断设备的理想类型与配置数量。各项任务需遵循以下步骤开展：

### 空间分析
**1) 开展可视性图分析（Visibility Graph Analysis, VGA）与步深分析（Step Depth, SD）**
按照《Depthmap_VGA_操作指南.pdf》中的说明整理平面图的DXF文件，可参考*VGA模型*文件夹中提供的示例平面图。
下载DepthmapX软件以运行可视性图分析（VGA）与可视化步深（SD）分析，相关资源可从同一来源获取……