Lanes, clusters, sightlines: Modelling patient flow in medical clinics

Lengthy waiting times for ophthalmology appointments in the UK's National Health Service (NHS) increased with the COVID-19 pandemic, necessitating a different approach to triaging patients safely and swiftly. Moorfields Eye Hospital NHS Trust therefore opened an additional clinic designed with a linear spatial layout and patient flow system, which is analysed in this paper in comparison with an existing clinic. By integrating direct observations of patient flows and an architectural layout analysis based on space syntax methods with queuing simulations from operational research, the results indicate that each clinic operates in line with its spatial logic and has its advantages and disadvantages. The newly opened clinic with a lane system supports flows and coordination through sightlines between stations, whereas the existing clinic with clusters of stations compensates by enabling a more organic flow, especially in conjunction with experienced technicians, which is beneficial when the clinic becomes busy. When high patient load is simulated in the queuing model, lanes result in slightly bigger bottlenecks and longer clinic durations. An ideal allocation of the number of stations to diagnostic activities based on clusters is suggested. This work contributes to combined architectural and operations research and the understanding of routines as performative. PRACTICE RELEVANCE By presenting the variability of diagnostic processes and ultimately their effectiveness through direct observations, this paper offers insights into the consequences of clinical design decisions normally taken by clinical teams or hospital planners with limited access to research evidence. Highlighting that both clinics have advantages and disadvantages, and suggesting principles for a better allocation and arrangement of resources (with stations in clusters, but with direct sightlines between them) can help future clinic design in ophthalmology and beyond. Other medical specialities with diagnostic procedures (such as orthopaedics, dentistry or audiology) might find the results insightful. This adds to the growing field of evidence-based design in general, and the sparse evidence base on outpatient clinics and patient flows in particular. The data are in an open-access repository for future use by clinicians, planners and academics.