Total Time in Clinic

1. Patient Tracker: A Simple and Effective Tool to Organize an Outpatient Student-Faculty Collaborative Primary Care Practice Tomi Jun, B.A.1, John Hegde, B.S.1, Sun Yoo, B.S.1, Aaron Berhanu, B.A.1, Alisa Yamasaki, B.A.1, Jane Zhu, B.S.1, Jennifer Katz-Eriksen, M.D.1,2, Kristin Remus, D.O.1,3, Pamela Vohra-Khullar, M.D.1,3, Amy Weinstein. M.D., M.P.H.1,3 1Harvard Medical School, 2Brigham and Women’s Hospital, 3Beth Israel Deaconess Medical Center • Background • Patient Tracker, a simple online, spreadsheet-based dashboard, enables monitoring and evaluation of operational management at the Crimson Care Collaborative Student-Faculty Practice at Beth Israel Deaconess Medical Center (CCC-BIDMC). • During clinic, Patient Tracker is updated by a student administrator to track the progress of each patient’s visit. • The literature shows that clinical time-flow analysis can help identify and rectify operational inefficiencies.1,2 • Since the clinic opened in January 2012, data from Patient Tracker has been used to inform operational changes in the clinic. • In order to determine if changes implemented based on Patient Tracker data improved clinic efficiency, we compared historical Patient Tracker data from our pilot session (1/24/12 – 3/20/12) and our summer session (6/5/12 – 7/31/12). * • Methods • Using Patient Tracker, total visit duration, wait-time duration, and the duration of every stage of the clinic visit were recorded for 28 clinic sessions from January - July 2012 (Figs. 1, 2) • Data was analyzed separately for two phases of the clinic: Pilot Session (1/24/12 – 3/20/12) and Summer Session (6/5/12 – 7/31/12). • Arithmetic means and 95% confidence intervals (CIs) were calculated for the time at each stage of the clinic visit. Figure 3: Patient Tracker data. *p ≤0.05 * Figure 1: Patient Tracker • Conclusions • Analysis of Patient Tracker data facilitated the identification of issues amenable to operational changes in the clinic. These changes likely contributed to the statistically significant reduction in patients’ total time in clinic, visit times, and student history-taking times between the pilot session and the summer session. • As a simple, low-cost online-based tool, we believe Patient Trackercould allow accessible simple time flow analysis in any clinic. * Wait #1 * • Results • Between the Pilot Session and the Summer Session, a statistically significant decrease was observed in three categories (Figure 3): • Total Time in Clinic declined from 91 minutes to 76 minutes, p = 0.02 • Visit Duration declined from 74 minutes to 64 minutes, p = 0.04 • Student History Taking declined from 32 minutes to 28 minutes, p = 0.05 References Xakellis, G. C., Jr & Bennett, A. Improving clinic efficiency of a family medicine teaching clinic. Fam Med33, 533–538 (2001). Racine, A. D. & Davidson, A. G. Use of a time-flow study to improve patient waiting times at an inner-city academic pediatric practice. Arch PediatrAdolesc Med156, 1203–1209 (2002). Berman, R. et al. The crimson care collaborative: a student-faculty initiative to increase medical students’ early exposure to primary care. Acad Med87, 651–655 (2012). Total Time in Clinic Visit Duration Wait #2 Time with Attending Figure 2: Clinic flow outline