Purpose: To decrease patient wait times within an outpatient specialty clinic utilizing event tracking time stamps after educating staff on the new standardized throughput process.

Description: A common concern heard in this clinic by patients and staff is that patients are often not ready to be seen by the physician at their scheduled appointment time. There are long wait times from the time the patient checks into the clinic until they are seen by the provider. Electronic medical record (EMR) event tracking has not been used to help with clinic flow, and overtime was incurred from additional hours worked in the clinic due to throughput issues. As a result, the nursing staff initially started completing manual time tracking on paper, only to realize this was time consuming and time stamps were being missed.

Efficient throughput times in busy ambulatory care medical clinics are an important factor for patient satisfaction, physician satisfaction, and overall staff satisfaction. Capturing data within the electronic medical system and using reporting tools within this system to display the events captured within the department’s patient schedule helped to determine the gaps of patient wait times within the clinic and formulated a plan to reduce these wait times and improve overall satisfaction between patients and staff.
After completing a systematic review of the literature, evidence was found that supported a practice change to track patients from the time they arrive in the clinic until they are ready to be seen by the provider through utilization of the EMR event tracking functionality.

The Rogers Diffusion of Innovations Theory guided the implementation change.
Prior to implementation, staff buy-in was established, education was provided to clinic and float pool staff, and event-tracking report criteria was defined.

Evaluation/outcome: Pre-implementation total encounter visit time averaged 81 total minutes. After implementation, this number reduced to 61 total minutes. After completion of this pilot clinic, other ambulatory care clinics who utilize this EMR have requested and adapted this process change.

In the spirit of transparency, the event-tracking reports are shared with each individual provider weekly by the nurse manager. These reports allow the providers to visualize opportunities for their clinic workflow improvement. Monthly staff meetings are used for analyzing information provided by the reports allowing for collaboration in problem-solving.

Tina Barnett BSN, RN

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