Using quality improvement methodology and tools to reduce patient wait time in a paediatric subspecialty rheumatology
Bayardo Garay1, Denise Erlanson2, Bryce A Binstadt3
1Medical Scientist Training Program, University of Minnesota Medical School Twin Cities, Minneapolis, Minnesota, USA.
Insights
Implementing a checkout sheet and staggered start times significantly reduced patient wait times in a pediatric rheumatology clinic. Process improvement methods lowered mean wait times by 17% and variation by 26%.
Area of Science:
- Pediatric Rheumatology
- Healthcare Operations
- Process Improvement
Background:
- Inefficient patient flow and long wait times were identified as significant issues in a pediatric rheumatology clinic.
- Baseline analysis revealed that the majority of patient waiting occurred after rooming, specifically while awaiting physician attention.
- Wait times were found to be independent of patient age, time of day, day of the week, or individual physician, indicating a systemic process issue.
Purpose of the Study:
- To reduce the mean patient wait time within the pediatric rheumatology clinic.
- To minimize the variation in patient wait times, ensuring a more predictable experience.
- To apply process improvement methodologies to enhance patient flow in an ambulatory care setting.
Main Methods:
- The study utilized a series of Plan-Do-Study-Act (PDSA) cycles to implement changes.
- Key interventions included the introduction of a checkout sheet and the staggering of patient start times.
- Data was collected and analyzed to assess the impact of these interventions on patient wait times.
Main Results:
- Following the implementation of process improvements, an initial 26% reduction in the variation of patient wait times was observed.
- The mean patient wait time was ultimately reduced by a final 17%.
- Crucially, the implemented changes did not negatively affect the duration of patient-physician contact time.
Conclusions:
- Process improvement methodologies, including PDSA cycles, checkout sheets, and staggered start times, are effective in reducing patient wait times in pediatric rheumatology clinics.
- These strategies can optimize patient flow and improve operational efficiency in ambulatory settings without compromising clinical interaction time.
- The findings contribute valuable insights to the literature on implementing process improvements in specialized outpatient clinics.
Abstract:
Our paediatric rheumatology clinic has experienced inefficient patient flow. Our aim was to reduce mean wait time and minimise variation for patients. Baseline data showed that most waiting occurs after a patient has been roomed, while waiting for the physician. Wait time was not associated with a patient's age, time of day, day of the week or individual physician. We implemented a checkout sheet and staggered start times. After a series of plan-do-study-act cycles, we observed an initial 26% reduction in the variation of wait time and a final 17% reduction in the mean wait time. There was no impact on patient-physician contact time. Overall, we demonstrate how process improvement methodology and tools were used to reduce patient wait time in our clinic, adding to the body of literature on process improvement in an ambulatory setting.
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