All patients know this feeling: Walking into a medical practice and waiting to check in. Next comes the waiting to be called. Then, alone in the exam room for two more rounds of waiting, first for the nurse then, at long last, for the physician.
Kulin believes the time it takes a patient to receive service is a defining factor in whether a patient will be satisfied with the care he or she receives. Kulin has built a patient flow system that emphasizes shortening wait times. Everything is focused on making it easier for the patient. “We continue to try and focus on: How do we find ways to make it easier for the patient in terms of quality, safety, access, communication with patients as well as with other providers?” Kulin says.
Before walking in the door, patients can check the Urgent Care Now website to learn the current wait times at the various locations. This allows patients to plan their visits when it is best for them, while at the same time ensuring that patients expectations of wait times are realistic.
When patients enter, they first encounter two iPads set up for registration. More than 90% of patients use the iPads to register, a process that takes as little as 10 seconds. Patients can use the iPad to make copayments, enter medical history and current medications, thereby saving staff time and allowing medical history and other information to become a discussion topic with patients, rather than a rote clerical job.
The practice also offers a text notification service to alert a patient when he or she is about to be called back, so patients don’t have to sit in the waiting room. “To me, the worst thing is someone who is ill or injured and now are sitting in a waiting room surrounded by other people in the same situation. It’s adding insult to injury,” Kulin says.
Most of the metrics that Kulin tracks and analyzes, with the help of custom reports his nurse manager has developed in the practice’s EHR system, are directly related to how long it takes patients to move through the encounter process and, by extension, how efficient his front office staff and providers are at accomplishing that. Important metrics include:
- check-in and check-out productivity,
- time spent chart documenting,
- the rate of same-day chart close,
- ordering of x-rays and other diagnostic tests,
- ordering of prescription drugs,
- overall visit time,
- patients seen per hour, and
- tracking e-mail collection for patient portal sign-up and phone number capture for secure messaging
Kulin knows the results for many of these metrics by heart. For example, he knows that his providers, across all his locations, average about 3.1 minutes on chart documenting, which in turn tells him a number of things—for example, how long providers are spending on documentation versus speaking with and treating the patient, a metric that affects how many patients each provider can see in an hour. The goal, Kulin says, is about 3 to 3.5 patients per hour.
“There are a bunch of different things we have in our dashboard,” Kulin says. “It allows us to look at the 10,000-foot view and drill down when we see an outlier, whether positive or negative, and using that outlier as an educational opportunity or include in best practices if someone has figured out a better way of doing something.”