Fast track’ puts clinic on the right track for patients
Express service means better productivity
Medical director Sharon Buttress, MD, and her access team wanted to know what happened to patients when they entered the CAMcare Health Corp. community health center in Camden, NJ. So they followed patients from the moment they walked in the door to the time they left, clocking each movement as they went.
Their findings: Patients spent an average of 31 minutes in the waiting room, then waited another 29 minutes in the exam room. They finally spent 12 minutes face to face with a physician or nurse practitioner; their total time in the clinic averaged 95 minutes. "Our patient satisfaction surveys told us, We like what you do, but we hate how you do it,’" says Buttress.
Just tinkering with the center’s processes wouldn’t be enough. The access team set out to re-engineer the system through a quality improvement project that was a part of a collaborative on "Improving Efficiency and Access to Care" of the Institute for Healthcare Improvement (IHI) in Boston.
In fact, Mark Murray, MD, MPA, co-chair of the Boston-based IHI collaborative, cautions medical groups to work on access along with efficiency issues. Process changes such as fast-track influence, not just cycle time but access to appointments, with a patient’s regular physician, he says.
The CAMcare team adopted the acronym NIKE, for "New Ideas — The Key to Excellence," with the motto, "Just do it!" The team focused on the patient experience as it sought to remove barriers — such as pharmaceutical representatives lingering in the hallways and distracting doctors — and create efficiencies.
"The office flows [now] around the patient," says Buttress. "The patient is central."
One primary change transformed the way the CAMcare center handled visits. With the support of several providers and CAMcare leadership, the center created an "express lane." Patients with needs that could be handled quickly, such as suture removal, blood glucose monitoring, or wound checks, went on a "fast track."
A dedicated team of providers and staff works just on the expedited visits. The team rotates onto the fast track, so the providers can see their regular patients on other days.
To make things even smoother, Buttress gave walkie-talkies to providers, receptionists, and medical assistants. Now, if doctors need a chart, they don’t wander the halls looking for someone to help. They just get on the walkie-talkie.
"Walkie-talkies allow the [care] team to communicate in real time," he says. "It was the team support and communication that made the difference."
When the access project began, providers saw an average of 2.1 patients per hour. Fast-track providers average 5.4 patients per hour. Those patients wait an average of six minutes; 60% of them are sent directly back to the fast-track team with no wait at all.
The center as a whole now has an average cycle time (patient arrival to departure) of 41 minutes. The average provider productivity has risen to 4.2 patients per hour. "[With fast track], we opened up capacity," says Buttress.
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