End long waits with patient flow analysis

Free software tracks patient-staff contact

Consider these typical situations: long waits in the reception area, more waiting time in the exam room, delays in getting lab results, delays in finding patient charts.

Those inefficiencies lead not only to lower patient satisfaction, but to frustration for physicians and staff. With software available free of charge from the Centers for Disease Control and Prevention (CDC) in Atlanta, medical groups can record and analyze patient flow to pinpoint and fix problem areas.

"Patient Flow Analysis [PFA] allows you to go in and assess where the backlogs are occurring in the system," says Julie Ellmore Jones, MBA, MHA, a consultant with Gates, Moore & Co. in Atlanta and a specialist in patient flow. Jones is a scheduled speaker for the annual conference of the Medical Group Management Association, Oct. 17- 20 in San Diego.

"The problem might be that you get the patients worked up, but you don’t have enough exam rooms," she says. "Maybe the problem is with the lab and the workup process. A lot of times it is related to the time of day.

"You want to keep the physician moving from exam room to exam room," says Jones. "You don’t want a physician outside tapping his toe wondering, Why isn’t my patient ready for me?’"

First developed for family planning

CDC first developed a patient flow tool in the 1970s to help family planning clinics control their personnel expenses. While cost is still an element, the current analysis is much more complex, says William Boyd, MA, public health adviser in CDC’s division of reproductive health.

Current software allows users to define up to 15 distinct services performed by staff or clinicians, such as taking a medical history or performing a physical examination. But the updated Window-based version, due to be completed by the end of this year or early 2000, will expand that potential to 625.

Looking at who is providing certain services can sometimes reveal simple changes that would add efficiency, says Boyd. "It may be that there are two staff people taking a complete medical history or two staff people taking a blood pressure check."

The software also analyzes patient compliance with their appointment time — whether they are on time, early, or late. While the current program uses 15-minute intervals (a patient who is 15 minutes late would still be considered on time), the new version will allow users to set their own parameters, Boyd says.

The sophistication of the patient flow analysis will continue to improve, says Boyd. "We expect to come up with annually new versions of PFA," he says.

Collecting the data is fairly simple, but it requires a commitment to accuracy, says Jones. A form is attached to the patient chart, and every employee who comes into face-to-face contact with that patient records the start and stop times of that contact. Staff and clinicians also have codes and a form on which they record the times they are available to work with patients and when they are on break or unavailable.

"Every single person in the office participates, from the check-in clerk to all physicians," Jones says. "The [rare] exception might be an office manager who has no patient contact whatsoever."

It helps to have someone who can monitor the data collection, she says. "In the beginning, there are a lot of mistakes. People forget to document their time. You have to monitor the forms at first and find the people who are making mistakes. If you don’t have good data, there’s no point in doing this."

Where did the time go?

The analysis tells medical groups how much time staff or clinician spent in face-to-face time with a patient, and what percentage of the patient’s time in the office was spent with face-to-face time with someone.

For example, in one analysis Jones conducted for a pediatric medical group, patients spent 79 minutes in the office, with 36% of it in face-to-face contact with clinicians or staff.

"We’re not going to be able to eliminate wait time altogether, [but] it should be 50% to 70%," she says. "As long as [patients are] in face-to-face contact with someone, [they] feel they are being cared for."

In the group, physicians spent 40% to 68% of their time in face-to-face contact with patients. "You want them to be spending 80% minimum of their time in face-to-face contact," she says.

Delays could be related to poor scheduling, or it could be inappropriate staffing, says Jones. For example, sometimes the addition of a medical assistant can actually save money for a practice by allowing greater productivity, she says.

Jones customizes the CDC software to fit the practice’s needs and uses the analysis to craft recommendations. She stresses that she isn’t simply looking at speed as a measure of productivity. "You get a lot of fear from the staff [who think] you’re measuring how quickly they’re doing things," she says. "We want them to do things at their normal pace. I try to go out of my way to assure them that I’m not here to assess their job. I’m trying to make things easier for them."

[Editor’s note: For a information packet and free patient flow software, contact William Boyd, Public Health Adviser, Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, at (770) 488-5130. E-mail: wab2@cdc. gov.]