Standardize Rooms, Equipment, Patient Flow, and Information Flow

Improving Primary Care Access

Standardization means reducing unnecessary variation in a process. In an office practice, reducing variation in exam room layout, equipment, and supplies means that providers and staff don’t have to waste time looking for needed items either before or during a patient visit. Standardizing the flow of patients and information ensures uniform, consistent, and reliable processes.

The important concept of open rooming is predicated on standardized exam rooms. Open rooming allows any provider to use any exam room any time it is available. This is in contrast to some traditional clinics, where exam rooms are assigned to specific physicians. For example, a clinic with a total of sixteen exam rooms assigns two rooms to each of its eight providers. On days when only five providers are in clinic, a traditional system would only use ten of the sixteen available rooms because the rooms are matched to particular providers. Standardizing all exam rooms leads to open rooming and allows all sixteen rooms to be used each day, maximizing the clinic's flexibility to rotate patients into available rooms, and thereby improving flow and decreasing waiting time.
 
To implement open rooming, the room set-up and inventory of supplies and equipment must be standardized in each room. Some clinics establish an initial standardization and then set up a room to test the new system and identify needed improvements. In some clinics, it helps to achieve physician buy-in to give providers a single drawer or shelf of their preference in the exam room.
 
It is also important to keep rooms fully stocked to minimize interruptions during the patient and provider interaction. First agree on the list of needed items and their placement in the room. Next, assign roles and responsibilities to keep the rooms fully stocked on a set schedule. Make this process as efficient as possible, and ensure that it is part of clinic policy and procedure.
 
In addition, ensure that each exam room has the standard equipment needed for the patient visit so that the provider does not need to interrupt the visit to call or look for needed and common equipment. For example, be sure that commonly used items such as thermometers, forceps, scales, oto/ophthalmoscopes, and blood pressure cuffs are located in each room. When there is a need for specific equipment or supplies, such as in certain specialty clinics, mobile equipment or special supply trays can be brought into the room as needed. This still allows for the standardized set-up of the rooms while also accommodating the need for specialized equipment or supplies.
 
Also, be sure that there are enough exam rooms for each provider. To be as efficient as possible, each provider must have enough rooms so that patient flow is optimized. This may vary by practice type and style. The idea is that a provider should always be in a position to move through the schedule from one room to the next, without waiting for a patient to be roomed. This means that the office staff must be able to keep one step ahead. If there are adequate rooms, the provider can be with the appointed patient while the staff deal with the needs of the previous and next patients.
 
To standardize patient flow start by following patients through your office practice. Eliminate any variation in flow that is not directly related to patient need. When patient need dictates a variation in the pattern of flow, look for sub-groupings. Some practices have developed rooming protocols that dictate when some patients may skip some or all vital signs.
 
To standardize information flow, start by tracking the current flow of information through the practice. Tracking information flow is more difficult than tracking patient flow since the streams of flow diverge and new parts flow into the main current. Track one type of information flow to assess your opportunities. For example, follow the information flow for a request for prescription refill from the first time the phone rings until completion of documentation and refill authorization or written/faxed prescription. Reduce the number of steps and people involved in the process. Improve turnaround time by using just-in-time processes.

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