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Improving Process Turnaround Time in an Outpatient Clinic Improving Process Turnaround Time in an Outpatient Clinic Antz Joseph University health services walk in clinic process flow Historically, medical residency teaching clinics provide the heart of medical services to an under-insured population through various government-subsidized health insurance programs.
These programs provide medical coverage for eligible individuals with incomes of less than 35 percent of the federal poverty level. It is well-established that people living in poverty are at a higher risk for chronic diseases, such as hypertension, diabetes, dyslipidemia, obesity and psychiatric disorders.
Low-income population groups may also experience barriers to receiving healthcare services, such as lack of transportation. Medical educational residency clinics are challenged to provide accessible, ongoing, quality care while being sensitive to the special needs of the population group they serve.
They also must maintain the goal to train new physicians in a fiscally viable manner. Nationally, residency teaching clinics have inefficiencies that cause long patient wait times. Patient wait time for medical care has a direct impact on patient satisfaction, medical compliance, return show rate and patient attitudes toward clinicians, staff and clinics in general.
Patient wait times to see an internal medicine resident physician in the Hurley FAHC exceeded the patient threshold, causing dissatisfaction, poor medical compliance and high no-show rates. Dissatisfied patients created a domino effect, leading to dissatisfied resident physicians and clinic staff.
The resident physicians became frustrated by not being able to manage clinic patients with chronic diseases effectively due to high no-show rates for follow-up appointments. The project was sponsored by the clinic manager, who monitored the patient satisfaction surveys.
The Hurley project was employed to determine clinic inefficiencies and to improve the patient flow process. The premise of this project was that decreased patient wait-times in the internal medicine clinic would increase overall patient satisfaction.
It was important to ensure that the core team and extended members included individuals that have direct contact with the process. During the Define stage, the team developed a high-level process map to help understand the larger process and to gain consensus for the overall scope of the project Figure 1.
High-level Process Map of a Patient Clinic Visit The process starts when the patient checks in at the registration desk and ends when the patient checks out at the end of the clinic visit.
The initial data reflected the total patient visit TAT to be an average of minutes from beginning to end. This process had an upper specification limit USL of 60 minutes, which was decided upon by the project sponsor. Measure The goal in the Measure phase was to determine a baseline metric of the identified overall Y TAT from start to finish.
The process map was used to identify each step, and a data collection tool was created to capture a metric for the designated incremental steps within the clinic.
The team decided to measure the time required to complete the following process increments: Patient checks into the clinic and clerical staff takes chart to holding queue Clinical staff brings patient to exam room and puts chart in resident holding queue Patient waits in exam for resident physician Resident physician sends patient to check out Patient waits to be checked out of clinic Baseline data for the patient TAT in the adult medical clinic was collected from Mar.
The results are represented by the process capability graph in Figure 2. Process Capability of Turnaround Time The sample N was patient visits, which reflected an average TAT of minutes, with a standard deviation of The USL of 60 minutes translated to a baseline defect per million opportunities DPMO rate ofand a corresponding sigma score of Based on these metrics, the Black Belt determined that the process met the customer expectation of a minute turnaround time 4.
In keeping with Six Sigma strategy, the team held a brainstorming session with frontline employees to delineate the perceived causes of delay and to get a broad employee prospective of alleged problems in the patient flow process.
The perceived causes are represented in the Figure 3. This was done by bringing the core group together again to perform a failure mode and effect analysis FMEA.
Each step of the process was identified and reviewed to determine its failure potential on a scale of 1 to 10 based on severity, frequency of occurrence and current detection methods.
These values were then multiplied to obtain a risk priority number RPN.The University of Nevada, Las Vegas (UNLV) is a public research university in the Las Vegas suburb of Paradise, vetconnexx.com acre ( ha) campus is about mile ( km) east of the Las Vegas vetconnexx.com university includes the Shadow Lane Campus, just east of the University Medical Center of Southern Nevada, which houses the School .
Case: University Health Services: Walk-In Clinic Kathryn Angel has been hired as assistant director for ambulatory care at Harvard’s University Health Services.
By implementing a triage system, she wanted to reorganize the Walk-In Clinic. Mayo Clinic Health Letter provides reliable, authoritative and accurate health information.
Discover why it is one of the leading health publications. The Adult Mental Health Clinics are part of a continuum of treatment and support services available for adults (age 18 and over). They provide a wide range of community-based services for people who are having significant problems related to their mental health and well being.
The University of Nevada, Las Vegas (UNLV) is a public research university in the Las Vegas suburb of Paradise, vetconnexx.com acre ( ha) campus is about mile ( km) east of the Las Vegas vetconnexx.com university includes the Shadow Lane Campus, just east of the University Medical Center of Southern Nevada, which houses the School of Dental Medicine— the only dental school in Nevada.
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