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Improving patient flow can reduce wait times and enhance the patient experience.
Courtesy of Altrendo Images\Stockbyte\Thinkstock

AAOS Now

Published 8/1/2012
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Amy Fletcher

Improving Patient Flow Yields Big Dividends

Improving patient flow can have an impact on many aspects of a practice’s success, including shortening wait times and increasing patient satisfaction. Depending on how the process is revised, it can also boost employee morale by using critical knowledge from within the organization.

Just ask Julie Meurer, health services manager at Panorama Orthopedics & Spine Center in Denver. Ms. Meurer recently led a team to develop and implement a new patient flow process that incorporates several important goals.

The project encompassed a sweeping overhaul of the clinic’s patient flow and process. It took priority in 2012 for several reasons, including the need to meet both internal and external customer service standards set by Panorama’s executive team. The product was simply not good enough—and incremental change was not the right solution, according to chief executive officer Eric Worthan.

“Panorama is transitioning electronic health record (EHR) vendors this summer, and putting new technology on top of our old operational model did not make sense,” said Mr. Worthan.

Based on patient satisfaction scores, two areas were targeted for improvement—patient wait times and the length of time to return patient calls. The goal was to improve operations so that the best quality care could be provided in the most efficient manner. The core team was also asked to incorporate ways for the practice to meet new government-mandated meaningful use standards such as recording certain vital signs and reporting on quality and quantity measures.

Moving and reassigning staff
Ms. Meurer, who started at Panorama Orthopedics as a medical assistant, understood how patients moved through the office. She recognized that some restructuring and standardization across service lines was necessary to achieve shorter wait times and enable staff to collect the new meaningful use information. These changes would not only make the patient flow more efficient but also improve the patient experience.

“We now have four staff members in each hallway to assist two physicians,” Ms. Meurer said.

Each physician has a staff support member, and two other staff members are assigned to each hallway. One of them is a patient care specialist, who is responsible for managing the daily flow of that particular hallway. The specialist updates patients on wait times, assists with completion of orders, and coordinates with other departments that have direct contact with the patient.

“With the change in roles, it was easier to speed up the visit because important information—such as vitals, medications, and allergies—was collected up front,” said Ms. Meurer. “Plus, the new process was implemented without increasing the staffing budget.”

Allocating resources
Another area targeted for improvement was length of time to return patient phone calls. To ensure adequate phone coverage, the practice’s information technology department analyzed how many calls each medical assistant received each day during a 4-week period, as well as how many minutes were spent on each call. Based on those numbers, subspecialty staff are assigned to ensure proper call coverage.

The results were impressive. After just 6 weeks, all patient calls were being returned by the end of the day. The goal is to return all calls within 2 hours, more quickly for urgent concerns.

The new process also takes into consideration that not all physicians see the same number of patients. So as to not overload staff working with physicians with higher patient volumes, a physician with a high patient volume shares the same hallway as a doctor with a lower patient volume.

Putting change into practice
Implementing change in any office can be challenging, and orthopaedic practices are no different. In this case, Panorama Orthopedics implemented the new patient flow process at the same time that it switched to a new EHR system.

The core team helped identify a more efficient way of collecting meaningful use criteria while continuing to provide excellent patient care. These changes have streamlined the patient experience and enhanced teamwork at the practice.

Panorama Orthopedics eased into the new process by running initial pilots with two physicians, one hallway at a time. As the staff became more comfortable with the new system, the practice gradually increased the number of hallways and physicians using the new patient flow system.

Now that the system has been in place for several weeks, staff members are beginning to appreciate the new process. “We are getting more buy-in,” Ms. Meurer said, “and they are coming up with their own suggestions on how each position can be used differently.”

It was a huge change, but the switch has paid off. Patients don’t have to wait as long to see a physician, and the practice has more resources to ensure that patients have a smooth visit experience. In addition, patient complaints about unreturned calls have virtually disappeared.

The focus now is on helping staff become more comfortable in their new roles and training them on the new EHR system. With staff specialization, the practice has been able to reduce the length of new training. What once took 6 to 8 weeks now takes just 2 weeks.

“I am incredibly proud of the cross-functional, team-based approach that went into designing thenew patient flow process, as well as the rigor and discipline used during implementation,” Mr. Worthan said. “We have created a better model that creates internal efficiency and will enhance the patient experience.”

Amy Fletcher is the public relations specialist for Panorama Orthopedics & Spine Center.