1. Improving the Patient Flow Process at the Morehouse Medical Associates Comprehensive Family Healthcare Center Morehouse School of Medicine Department of Family Medicine November, 2009

3. Background of CFHC  The Morehouse Medical Associates (MMA) Comprehensive Family Healthcare Center (CFHC) was established by the Department of Family Medicine to provide complete medical and preventive healthcare services to all communities, with a special focus on minority and underserved populations.  The Department had two primary clinical sites, the Comprehensive Family Healthcare Center (CFHC) and the Family Medicine Center (FMC). The 5,000 sq.ft. FMC was the family medicine residency teaching site for approximately 20 years. Due to accreditation citations, the 14,000 sq.ft. CFHC was designed and opened in July 2004.  However, due to decline in revenue and patient volume, FMC was closed with the plan to consolidate the practice into the CFHC.

4. Background (continued) The Comprehensive Family Healthcare Center is located in the greater Atlanta metropolitan area.  16 full time staff  15 residents  20 physicians  1,306 visits per month  1,033 patients

5. Problems  Indirect effect on efficiency of patient flow  Directly a source of patient’s dissatisfaction  No routine mechanism for communication exist  Loss of revenue by increase walk away

6. Objectives 1. Increase patient satisfaction 2. Increase patient numbers 3. Retention of patients 4. Decrease overhead 5. Increase Revenue 6. Enhance patient/physician relationships

7. General Mission Statement A collaborative approach to implementing an interdisciplinary process designed to improving the delivery of preventive, diagnostic and therapeutic measures in order to  Maintain, restore, and improve health outcomes of individuals  Improve patient flow to maximize clinical efficiency

8. AIM Statement  To improve patient flow at the Comprehensive Family Healthcare Center by 30% above the present baseline over a six month period.

9. Patient Flow through the Clinic Pt. signs in Pt. checked in Encounter is placed on wall Pt. triaged No Yes Back to waiting Pt. placed in a room area Student Resident Faculty Preceptor Orders Writes prescription Preceptor sees pt. Lab Check out Resident (prescription) Resident discusses plan with pt. Lab Check out

10. Fish Bone Diagram   Schedule Triage Time to check out   - Over booking - Room availability - Lab  - Walk-in - Staff : MD - Chaperone  - Injections  - Precepting  - Physical struc.   Start End  - Paper work completion - Punctuality  - Insurance Check - Does not know pt.is in rm  -IDX not interfacing - Completing EMR in-  between pts   Pt. Check in Triage to MD  in Room

11. Pilot time-tracking log Appointment Time:_____________ Patient Check-In:_____________ Encounter On Wall:_____________ Patient in room:_____________ Doctor in room:_____________ Lab:_____________ Patient Check Out:_____________

12. Leverage Point  Long wait time between placing the patient in a room and when the physician enters that room.

13. Barriers to Successful Patient Flow  Physician punctuality in the clinic  Preceptor’s late or no show to clinic  New residents each year – PGY 1  Front office staff shortage  No printers in resident work area

14. Goal  To decrease the wait time from patient arrival to MD entering room from 58 mins to 30 – 45 mins. This will decrease the overall wait time and efficiency in the clinic.

15. Interventions  Installation of magnetic timers on exam room doors (set @ 30 min intervals)  Assigned a physician for walk-in patients  Logged physician arrival time to clinic  Encouraged standing orders by healthcare providers.

16. 2 nd time-tracking form

17. Pre (min-%) Post-Intervention  Arrival-Appt -10.2 -8.5  Arrival-Wall 19.6 (16%) 18.9 (19%)  Wall to Room(Rm) 26.3 (22%) 18.3 (19%)  Pt -MD in Rm 29.5 (24%) 20.7 (21%)  MD in Rm-MD comp 27.3 (28%)  MD comp- Ck out 12.9 (13%)  MD in Rm-Ck out 46.3 (38%) 40.2 (41%)  Arrival-Ck out 121.8 98.0 (20%)

18. -10 mins -8.5 mins

19. 19.6 mins 18.9 mins

20. 26.3 mins 18.3 mins

21. 29.5 mins 20.7 mins 

22. 46.3 mins 40.2 mins 

23. 121.8 mins 98.0 mins

24. Average Time Arrival to Checkout  Day 1 - 103 mins  Day 2 - 105 mins  Day 3 - 90 mins  Day 4 - 103 mins  Day 5 - 129 mins  Day 6 - 115 mins  Day 7 - 95 mins  Day 8 - 109 mins  Day 9 - 100 mins  Day 10-108 mins

25. Limitations  Incomplete survey entry.  Peoples times were not synchronized  Wrong time entry by residents  Small sample size

26. Principle Conclusion  The total wait time was decreased by 20%: from 122 mins down to 98 mins  There was an increase in patient satisfaction

27. What’s next……………………..  To change the health providers template.  To survey the patients with regards to improvement in wait time.  To post results of survey in key areas along with the goals. - Front Office - Nurses Station - Residents Area - Faculty/Preceptor Areas  Second survey in 12months.

28. Literature Review  www.aafp.org/fpm/20050400/61maki www.aafp.org/fpm/20050400/61maki  www.aarp.org/fpm/20070500/46effi www.aarp.org/fpm/20070500/46effi  www.aafp.org/fpm/990400fm/38 www.aafp.org/fpm/990400fm/38  Advance Data from Vital and Health Statistics, no.346, Aug.26,2004  www.storkdoc.blogspot.com/2007/08/why-we-wait- so-long-in-waiting-room www.storkdoc.blogspot.com/2007/08/why-we-wait- so-long-in-waiting-room  Study on Outpatients’ Waiting Time in Hospital University Kebangsaan Malaysia (HUKM) Through the Six Sigma Approach by Mohamad Hanafi Abdullah.