Improving patient flow in the outpatient clinic

Kimberly Ku., Lance Heilbrun., Daryn Smith and Elisabeth Heath

Rationale, aims and objectives: Improving patient flow increases patient safety, improves clinical
outcomes, positively impacts patient and staff satisfaction, and increases revenue. Factors
contributing to lengthy waiting times for patients include long registration processes, obtaining
laboratory results, preparation of chemotherapeutic agents, adequacy of human resources, and
physical capacity meeting patient volumes. We aimed to study and test changes that would decrease
waiting times at the Barbara Ann Karmanos Cancer Institute (KCI) Wertz Outpatient Clinic by at
least 20% by the end of the 12-month study period (April 15, 2012 to April 15, 2013), without
incurring extra cost or resource burden.
Method: We used the IHI Model for Improvement to identify bottlenecks to develop and test
changes for implementation. We estimated the mean and standard deviation (SD) of patient transit
times, both before and after implementing an intervention(s).
Results: At baseline, patients’ mean total transit time (TTT) was 139.5 minutes. After intervention
1, (a different set of 19) patients’ mean TTT was 131.1 minutes, a reduction of 8.4 minutes or 6.0%.
The implementation of intervention 1 was the addition of 5 minutes to normal appointment times
allocated for seeing the oncologist. A second intervention was planned but not executed in time
during the study period.
Conclusion: A mean reduction of 6% may not be of large benefit per an individual patient.
However, such a reduction may be worthwhile from a clinic operations improvement standpoint.
There were limitations to this pilot study, which present as areas for improvement in further study.

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