Improving Primary Care Access
Definition
The office visit cycle time is the amount of time in minutes that a patient spends at an office visit. The cycle begins at the time of arrival and ends when the patient leaves the office. (Note: The cycle time does not include time spent in laboratories or radiology during primary care visits. Specialty clinics may opt to include testing and procedure time in total cycle time since these activities are an integral part of the planned specialty care visit.)
Both primary care and specialty teams clinics may wish to distinguish between the time the patient spends with the physician or other members of the care team ("value-added" time) and the time spent waiting ("non-value-added time"). The goal is not to reduce total cycle time but to maximize the time the patient spends with the physician or other members of the care team.
Office visit cycle time serves as a balancing measure for Time to Third Next Available Appointment. Balancing measures ensure that improvements in one area do not have negative consequences in another. For example, a clinic may improve its access but require patients to wait longer in the waiting room unless they are also working on ways to improve efficiency and patient flow.
Goal
Decrease the office visit cycle time to 30 minutes or 1.5 times the actual time spent with clinician.
For example, if the average patient spends 20 minutes with a clinician during the office visit, then the goal for the office visit cycle time would be 30 minutes (1.5 x 20 minutes = 30 minutes).
Data Collection Plan
Sample a minimum of 15 patients per week on a pre-selected day and time. Use the same day and time of day each week. Selecting a time during the day that is often the busiest in the office (e.g., mid-morning for adult clinics, late afternoon for pediatric clinics) is a good method to ensure that the data captures the true capability of the system. At the agreed-upon start time, begin recording the time each patient checks in to clinic registration and the time the patient checks out. Stop collection when the data from 15 patients has been recorded. The clerk in the registration and/or check-out areas can record each person’s name (or identifier) and time. If patient arrives early, time starts at scheduled time of appointment. One method for measuring the amount of time for each step in the patient visit (value and non-value added time) is to use a patient cycle tool. The patient takes the cycle form with them throughout the visit and records the time that each part of the visit begins (e.g., time the staff member left in the waiting room, time the provider came into the room, etc.).
The
Patient Cycle Tool is a simple, one-page data collection sheet for this measure. Patients or staff can fill out the sheet.
