How Door Timings Tell the Story of Patient Care

November 17, 2015

This MD started writing down the time she entered and exited an exam room to track patient flow. The data revealed a lot.

This week, my practice started doing door timings. We do these periodically to study patient flow. A spreadsheet is taped to the door and the medical assistant writes down what time they enter and exit the room, followed by the provider writing down entry and exit times. It allows my practice administrator to see how long patients are waiting, how long it takes to room a patient, whether I am chronically behind, and where hang-ups may exist in our patient flow.     

These door timings have an effect on my behavior. For example, I push myself to be more on-time because I hate to see written evidence of my delays. I also am amazed by how long I actually spend in the exam room. I usually see patients about every 20 minutes, but I rarely spend that much time in the exam room. In fact, for a focused visit, I might only spend six or seven minutes face-to-face with the patient. This begs two questions.  First, why does it feel so much longer?  Second, what in the world am I doing with the rest of my time?

For the first question, I suspect my appointments feel much longer than they are for the same reason that I am statistically likely to interrupt a patient after they’ve been talking for only eleven seconds. I think fast. I try to be efficient. Long answers and extraneous details can frustrate me.  However, the black and white reminder of the time I actually spend in the room reminds me of why I should just listen for the first two minutes of the visit.

What I’m doing with the rest of my time is a mystery. I feel as if I spend 90 percent of my time face-to-face with patients. In fact, it may be closer to fifty percent. That’s sobering. It means that I am often staying late after clinic to finish work, not so I can spend valuable time with my patients, but so that I can spend valuable time doing something else. Of course, phone calls and medication refill requests eat up a large portion of my in-between visit time. I also have to document and enter orders and sign faxes from the nursing home. Plus, there’s at least one case that sends me to the literature to investigate a disease or treatment. The fact that I have a lot to do that’s not patient care is not surprising.  What is both surprising and sobering is how much time that ends up taking.

Readers, you may find it helpful to do a similar exercise. If you are, like me, spending at least half your time away from your patients, it may be an indication that you need to delegate work or re-prioritize your non patient-care activities. I will be doing the same.