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East Albany (GA) Medical Center does things a little different from the typical medical practice: The support staff escorts patients and takes vital signs; a nurse reminds the patients of unpaid balances; and the entire 56-member staff, from the front desk to the providers, can be in constant communication with each other via walkie-talkies. And it works.
The clinic, in rural south Georgia, sees more than 39,000 patients a year. Patients can get an appointment within 24 hours after calling, and all patients, including walk-ins, are in and out in 45 minutes or less.
After an extensive re-engineering project geared toward increasing efficiency and improving patient access, patient satisfaction is at an all-time high and collections are up. And the project costs very little because it uses common, off-the-shelf technology such as cordless telephones and electronic databooks. The redesign project took place over a six-month period as four members of the clinic staff attended a six-month course in re-engineering and applied the techniques they learned to improve patient flow.
"The seminars taught us about redesign and thinking outside the box. We took those concepts and started applying them in our clinic," says Ron Malcolm, PA-C, a physician assistant and leader of Team Delta Force, the redesign team. Other members of the team were Bernard Scoggins, MD, medical director; Diane Carter, business manager; and Belinda Morrison, RN, nurse manager.
After a 90-day implementation period and trial, the redesign team is currently in the process of expanding the redesign to include the other six clinics operated by Albany Area Primary Health Care. The program has received an Innovations in Health Care Award from the American Academy of Physician Assistants/Physician Assistant Foundation/Pfizer recognition program. "Our clinic was chosen for the redesign project because it’s the busiest and often the most frustrating for staff," Malcolm says.
The 18 physicians and 10 physician assistants treat 39,000 patients a year in a rural part of Georgia that ranks high in morbidity and mortality statistics, including AIDS and infant mortality. The goal of the project was to increase efficiency at the clinic and cut down on lengthy waiting times for patients.
The team started out by doing detailed measurements of patient flow. Each team member followed patients one at a time from the time they walked in the clinic door until they left. This helped identify the problems and bottlenecks and came up with way to correct them. The solution was to change the way the clinic operated and enhance communications by using inexpensive, off-the shelf technology including walkie-talkies for all staff, electronic data books and cordless telephones for the nurses, and computer terminals in all the treatment rooms.
"We used everyday equipment that doesn’t cost much. If you really take the time, you can see that there is a better way to do things at very little cost," Malcolm says. The biggest cost was $12,100 for buying and installing the computers in each treatment room.
The staff of 56 is divided into teams, which include a front desk clerk and a records clerk as well as the provider and the nurse. Some of the clerks work with more than one team. "A critical part of the redesign was training everyone on the staff to be a part of the team," Malcolm says. For instance, the front desk people and records people are trained to escort the patient to the treatment room and take basic vital signs like weight and height. "They need to understand about privacy and how to treat patients courteously. Instead of a skilled nurse taking time to escort the person, the other staff can do it," Malcolm says.
Initially, the nurse director provided the training. The clinic has worked with a local technical school on a cross-training curriculum. When the clerks have finished their training and meet the proficiency standards set by the practice, they will get a step raise in hourly wages. "They are really excited and love being part of the team. It makes them feel involved with the patients," Malcolm says.
The clinic couldn’t afford to put telephones in each treatment room but was able to purchase six 900 MHz cordless phones for each team’s nurse to use. The nurses also have electronic databooks that include the pharmacy names and telephone numbers. This way, if a patient is in the treatment room and isn’t sure whether her medicine needs refilling, the nurse can call the pharmacy. The process has greatly reduced the number of phone calls for prescription refills, Malcolm says.
"We had been inundated with elderly patients calling us after their visit to say their prescription needed refilling. It added a whole level of additional work, pulling the chart, getting the approval of the provider, calling the pharmacy. This way, the proper number of refills can be made because the nurse knows when the follow-up appointment is."
The practice installed computers in each treatment room to help minimize patient movement and increase efficiency. For instance, when a provider finishes with a patient, the provider calls the nurse over the headset, says the patient needs an appointment in three months, and gives the medication that needs to be refilled. The nurse can come into the treatment room, schedule the appointment, and call in the refill. If the nurse is busy, someone from the front desk comes in and checks out the patient.