| Primary Author: | Kathy McCarthy, BSN, RN |
| Co-Principal Investigators/Collaborators: | Jackie Ward, Heidi Russell, Paulette Reed, Marilyn J. Hockenberry |
| Organization: | Baylor College of Medicine |
Abstract
Background
A large pediatric cancer center has an extremely busy outpatient clinic including high patient volume, complex/varied disease types, and multiple providers. Efficient, timely patient care is a long-standing goal. In spring 2010, a goal for improving patient flow by decreasing the total office visit (OV) time for returning patients was established. A baseline work flow study showed the average OV cycle time (total of lead and process times) was 2 hours 1 minute; 47 minutes process time, and 1 hour 14 minutes lead time. Also identified was significant variation in number of OV’s and number of scheduled providers by day of the week.
Purpose
To reduce OV cycle times to an average of 90 minutes and balance the number of OV and providers.
Methods
A Quality Transformation multidisciplinary group representing all aspects of patient care in the outpatient clinic was formed. A new work flow was designed to consolidate the steps involved with OV’s with goals: lead time – 15-30 minutes, process time- 50 minutes, and total cycle time- 90 minutes. Physician team leaders were asked to determine the number of providers in clinic daily and tasked with assisting to organize provider’s schedules. Communication to the large number of providers and staff was accomplished with small group/Town Hall meetings. Implementation occurred in June 2010.
Results
In August a post-implementation time study was performed on 231 patients, recording the times from initiation to completion of each routine clinic office visit. The time study results showed the average OV cycle time decreased to 95 minutes; 51 minutes process time, and 44 minutes lead time. Average number of OVs by day of the week revealed less variation (Monday, 68; Tuesday, 56; Wednesday, 70; Thursday, 59; Friday, 65).
Conclusion
The reduction in the time patients/families spend during OV’s has had a significant impact on overall patient satisfaction. Outpatient clinic scores for the Patient Satisfaction Survey increased from June (92.9%) to September (96.0%).
© Improvement Science Research Network, 2011