GROWING WISER AND WIDER: THE COST-BENEFIT OF UNIVERSAL DESIGN IN MITIGATING LIMITED MOBILITY IN URGENT CARE SETTING

Purpose: Between increasing age and obesity, clinics are seeing more patients with limited mobility (LM). Universal design seeks to provide access for all regardless of mobility. We examined the trade-offs between an increasingly LM population and a clinic’s ability to accommodate them.

Methods: We developed a discrete event simulation model in Arena of an outpatient clinic. Base-case demographic data was derived from the literature and hospital electronic medical record. Process flow data came from a RFID-base real-time location system data which provided information on wait time, encounter time, and flow time. Additional costs incurred by introducing universal design included kneeling beds that accommodated both the frail and morbidly obese, transport technicians, and rental cost of larger rooms for access of mobility devices such as wheelchairs. Base-case assumed a four-physician practice, one-nurse/two-physician, and one-transport technician available. Sample size was derived from the variability surrounding pilot-run throughput and flow-time data. Sensitivity analyses were conducted on the proportion of patients classified as LM, the proportion of Universal access (UA) rooms available, and the additional cost of implementing UA. Standard univariate and multivariable statistical analyses were performed (JMP SAS).  

Results: Access to clinical services was highly sensitive to the proportion of LM patients in the population. In the Base-case, we found 18.5 patients per clinician per day with the net clinic income of $5454 per clinic per day. Without implementing UA, net income was negative when percent LM exceeded 20% and patient throughput dropped > 75%. If the Base-case rate of LM was held constant and UA varied, access (throughput) remained constant once UA > 10% of the clinic time (e.g. UA swing room). As percent LM rises, increasing UA slows the fall in throughput by between 1 to 6 patients per day relative to the baseline, but net income becomes negative under all conditions when percent LM ≥15%.  

Conclusion: It is likely that the proportion of LM patients will continue to rise as our population ages and the incidence of obesity increases. Due to the sensitivity of clinical flow to the proportion of LM patients, the demographic shift is likely to have a significant impact on access to care sooner than anticipated. Universal design is one tool that holds promise to help mitigate the access problem.