Improving clinic efficiency of a family medicine teaching clinic

Teaching clinics are the heart of training programs in family practice. It is in these training clinics where residents develop their ambulatory practice habits. Yet, little is known about the efficiency of these teaching clinics.

We conducted a time-and-motion study of patient flow in a residency teaching clinic.

During each half-day session, 7.8 +/- 1.9 providers were scheduled in clinic, and 55.5 +/- 12.9 patients were seen. First-year residents saw 3.55 patients per half-day session, second-year residents saw 4.75 patients, third-year residents saw 8.0 patients, faculty saw 8.22 patients, and urgent care saw 8.35 patients. The number of patients scheduled was highly correlated with the number of providers in clinic. Of the patients scheduled, 25% failed to keep their appointment, and 31% arrived late. Neither rates of no-show patients nor rates of late patients varied by level of provider. The mean time patients spend in the clinic was 80.5 +/- 30 minutes, with 17 +/- 10 minutes spent registering, 18 +/- 17 minutes spent being roomed, and 19 +/- 16 minutes spent waiting for the provider. The physician spent 27 +/- 16 minutes with the patient, including both face-to-face time and precepting time. Patients who arrived on time waited significantly longer than those who arrived late. Waiting time did not vary significantly by level of physician. The time patients spent with their doctor did vary significantly by level of physician; first-year residents spent more time with their patients than upper-level residents or faculty.

Significant variation exists in the patient flow through the clinic. Patient volumes are significantly correlated to the number of providers in clinic. Long waiting times are due in part to long processing times and in part to long waits in the exam room. Concerted multidimensional efforts are needed to smooth out patient flow and improve clinic efficiency.