10/6/2015. Specialty Care Center: Clinic Flow Improvement. Specialty Care Center: Improving Clinic Flow. Objectives

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1 Specialty Care Center: Clinic Flow Improvement 2015 Seton 1 Specialty Care Center: Improving Clinic Flow Executive Owner: Jennifer Harrison, RN, MSN, NE-BC, CPN Ambulatory Services Council (ASC) Chair Director of Ambulatory Specialty Services Working Owner: Lisa Farrens, MSN, RN, CPN Analyst: Patrick Boswell Pediatric Market/Clinical Quality and Operational Effectiveness 2015 Seton 2 Objectives Describe how a fishbone analysis and process map can be used to examine the root cause of wait times for patients in the outpatient clinic setting Identify four interventions to decrease waiting time for patients based on root cause analysis 2015 Seton 3 1

2 Goal Increase throughput capacity by reducing patient processing time through check-in, registration, and time spent in the clinic lobby by 10% Improve patient satisfaction as evidenced by increasing the overall quality of care scores by 2% Seton 4 Why this project? Clinic patients at the SCC were not moving efficiently through check-in and registration AVERAGE WAIT time 39 minutes Patient experience surveys Staff and Physician satisfaction 2015 Seton 5 Key Stakeholders Registration staff and supervisor Registration management team Clinic Coordinators(RNs and LPN) Physicians and Nurse Practitioners Director of Ambulatory Services 2015 Seton 6 2

3 Structure Meetings Monthly meetings with key stakeholders to drive the project Data Collection Time Study Staff and Physician interviews Key stakeholder brainstorming Fishbone Analysis Process Mapping 2015 Seton 7 Environment Default Test Fishbone Analysis Process Room availabilty More rooms needed for Clustered Registration takes > 7/8 Min per patient Parental consent unavailable Patient questions PAR stickering charts Registration booths More registration booths CA's unavailable Multiple clinics scheduled Problem S Patients a are waiting of 37 minu being brou a room More HCP, CA's, reg. staff needed per More clinic days/hours -availabilty of Lack of staff Label maker Not working efficiently RN's not bringing pts Not aware of waiting patient Registration system Documents being scanned into Not arriving on time People Measurement Machines 2015 Seton 8 What was the starting point? Registration Process Map 2015 Seton 9 3

4 Root Cause Analysis Why are patients waiting? The Patient Access Representative (PAR) is registering patients while placing demographic stickers on charts. Lack of variable registration staff at the start of high volume clinics. Lack of resources (not enough computers available to register patients). Cluster scheduling at the beginning of high volume clinics Seton 10 Time Study SCC Clinic Flow Time Study Place Patient Label in Box PLEASE MARK BOX with X Full Registration Add-On Volunteer Present TIME CLINIC- MARK with X Appointment Time Cystic Fibrosis-ADULT Patient Arrival Cystic Fibrosis-PEDS Registration Start Foot/Ankle Registration Finish Trauma Chart given to CA Cast ROOMS FULL YES NO Spina Bifida CA Assessment Start Musc/Skel Tumor Patient in Room Sports Med Patient Leaves Room Orthopedics Checked Out Trach/vent Aerodigestive Neuro Muscular Spine COMMENTS 2015 Seton 11 Interventions Sticker patient info before the clinic starts FAQ document and maps for patients If 3 patients are waiting to be registered a 3 rd person will be called to help out with registration. Created a portable registration cart 2015 Seton 12 4

5 Interventions Utilizing a volunteer at the front desk The registration staff will help with check- in if not registering patients. Registration staff prints paperwork prior to clinic. Prioritizing patients according to appointment time Seton 13 Process Change 2015 Seton 14 5

6 RESULTS The average wait time decreased from minutes to minutes, which equates to a 15% reduction in time patients spent waiting in the lobby. The Patient Experience Quality of Care Score increased by 7.9% Seton 16 Quality of Care Jan % March % June % 2015 Seton 17 Next steps: Next Steps Adopt the new registration process Adapt the clinic schedules More frequent time studies Expand project to include total throughput 2015 Seton 18 6