Ambulatory centers have many opportunities to minimize patient flow bottlenecks through operational adjustments. Some of our solutions to move patients through their visits faster include reducing Average Length of Stay (ALOS),which increases patient satisfaction and allows more patients to be treated in the same existing space, forestalling physical expansion.

One of our recent clients utilized a registration process that required patients to check in at both a main registration desk and again, at their specialist clinic on each and every visit to their doctor. There are three distinct disadvantages to this process:

  • Each visit required an additional 5-10 minutes for registration.
  • Square footage at each specialty was utilized for registration rather than for additional treatment space.
  • Most patients viewed the extra steps as cumbersome and tedious.

Catalyst proposed that the clinic or physician practice preregister as many patients as possible over the phone, by mail, or via a patient electronic portal, given that appointment times were scheduled well in advance. During the first visit, the patient checks in at the main desk to verify address and insurance information, but on subsequent visits, the patient would proceed directly to their doctor’s office. This way, more space could be dedicated to treatment functions and additional patients could be accommodated.

Catalyst has also tested numerous registration configurations to see which resulted in the shortest patient wait times. We used computer simulation modeling to measure the results of multiple scenarios without having to actually implement them. We studied different numbers of registrars for the medical office building as a whole, the number of registrars dedicated to each specialty, whether specialties shared registration staff, and combinations thereof.

Our testing affirmed that the most successful configuration involved one centralized registration area at the main entrance, with all registrars capable of registering any patient regardless of specialty.

However, this solution was dependent upon the integration of electronic information. If the Lab wasn’t able to transmit information to the main registration desk, the patient would need to go there in person to check in again.

Movement between Areas

Technology and cross communication are key. In a multi-practice facility, each area must be electronically connected. By tracking the operational and data flow from a patient’s perspective, the Ambulatory Center can best determine clinic adjacencies, information system requirements, and staffing model.

Manipulating hours of operation

It will come as no surprise that extending hours of operation enables a clinic to treat more patients; however, more hours do not necessarily mean more patients. Most people won’t visit a clinic at 3am just because it is open at that time. But if you have a queue of ten patients lining up at the door when you open at 9am, you should consider adjusting your opening time to 8am. If you still have a queue of five patients at 8am, back up the time to 7am.

The goal is to have a steady stream of patient arrivals rather than groups of patients entering the system simultaneously.

Pre-Op Testing
In many clinics, the different functions of pre-op testing are performed in separate spaces, so providers struggle with the ebb and flow of patient volume not aligning with each of the available, specialized rooms. As a solution and example, Catalyst has implemented 10 multi-function rooms, supplemented with portable equipment rather than dedicate 5 EKG rooms and 5 lab rooms separately.

As part of all of our surgery projects, Catalyst studies the patient flow from the entry to pre-op to surgery to post op. Because pre-op is used primarily in the morning and post-op in the afternoon, these areas can share the same rooms. This model requires less space, because a shared pre-op/post-op room requires approximately 20% fewer beds than separate rooms.

We can decrease throughput time and, ultimately, wait time by manipulating a design’s quantity of changing rooms and the size of the waiting space. This requires different staffing and operational models.

Decentralized waiting spaces help to minimize bottlenecks by queuing and moving patients through their visits. Without them, patients going from registration to changing directly to the modality would negatively impact departmental throughput and reduce utilization of expensive equipment.

Even though different patients visit the facility for different imaging modalities, providing separate changing and waiting areas for each modality could result in uneven utilization. Where appropriate, shared changing and waiting spaces between modalities reduces the potential for bottlenecks.

For many providers, improving the patient experience represents a significant opportunity. In working with providers throughout the country, Catalyst staff have helped clients alleviate a wide range of challenges affecting the patient experience by implementing operational process improvements to achieve reduced wait times and efficient office visits.