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Patient Flow, Stop the Bottleneck


Most medical practices experience some type of patient bottleneck. The good news is there's a solution, if you just look hard enough.

Most medical practices experience some type of patient bottleneck - whether it be inbound phone calls or cramped exam rooms. And most would welcome a way to conquer them, especially since they compromise workflow and time management. The good news is, no matter what the cause of a typical bottleneck, there is a solution lying somewhere in your midst.

Here are a few of the most typical causes of bottlenecks and their solutions (some more relevant in a small practice, and others more likely to be seen in larger practices.)

1. Inbound phones at check-in

When inbound calls are answered at the check-in station it kills production and makes it impossible to provide a positive patient-centered experience. If the receptionist is on the phone when a patient arrives she must either ignore the patient and continue the call, or interrupt the call and do the right thing: greet and meet the arriving patient's needs. This can be done with ease if the phones are removed from check-in. The front-line receptionist's primary focus should be greeting and processing patients arriving for appointments.

2. Lack of preparation

Being organized and preparing for the inevitable can help avoid any number of problems. Pull your team together and huddle to discuss what could have gone better today and look at the upcoming schedule of patients for tomorrow. Be sure all chart notes, lab results, diagnostic testing, and other reports are up to date in each patient's record. Also, have your staff make sure each patient is doctor-ready when the physician enters the exam room - leaving the exam room to obtain missing information or waiting for a patient to disrobe will only create a logjam, forcing patients who are checked-in to wait overlong to be roomed.

3. Poor scheduling

If you're scheduling patients who are being seen for a variety of simple and complex health issues, giving each of them a 15-minute time slot, you have a problem. It's a silent bottleneck, one many providers may not realize exists. That's right, just because everyone has been checked in and roomed doesn't mean you don't have a clinical bottleneck. Think about this: If you have patients in four exam rooms only one is with the doctor, the other three are waiting and waiting and waiting. Each one will end up waiting at least 45 minutes, as they wait for the three patients before them to be seen - and so it goes all day long.

Create a strategic scheduling template that addresses how much real time you need on the schedule for the most-common conditions you treat. It's wise to give new patients an extra 15 minutes for the nurse to take a proper history. And ask them to come in 15 minutes early to fill out paperwork. Better yet, have downloadable patient forms on your website and instruct patients to fill out the patient information sheet and the health history form before they come in for their appointment.

4. Space and function

Problems in the design and utility of medical offices can also cause bottlenecks. One potential problem is a design that results in poor patient flow. For example, I visited one practice where they had eight physicians and only one patient bathroom that was at the far end of the suite. If a patient needed to use the restroom after he was escorted to an exam room, he had to walk down the hall and wait behind other patients. This bottleneck jammed the hallway and nurses lost productivity while they waited for patients to come back to their assigned rooms.

Another example is the weigh-in station. Three nurses waiting to weigh patients before they can be roomed are indeed stuck in a bottleneck. Patients wanting to take off their jackets and shoes so they don't tip the scale exacerbate this problem. Come on everyone, scales aren't that expensive - put one in every exam room. Besides making the practice more efficient, patients are happier. They hate to be weighed in an open hallway.

An important thing to consider when looking at a bottleneck is that there is often more than meets the eye. Sometimes you need to look downstream to see what repercussions might exist if you fix the bottleneck. In one practice assessment Capko & Company performed the staff was proud that they had wired down the check-in process only to discover the patients were then backing up at the triage station!

Judy Capko is a healthcare consultant and author of the popular books "Secrets of the Best Run Practices," 2nd edition, and "Take Back Time." Based in Thousand Oaks, Calif., she is a national speaker on healthcare topics. She can be reached at www.capko.com.

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