Office Visit Cycle Time and Touch Time

[Guest guest]

I wasn't sure what the recent topic was about on Cycle Time.

Interesting stuff out there...see below.

I think the interesting comment below was that it might not be just the office cycle time, but the "touch time".

Wonder how this works for the solo-solo practices where ALL the time is kind of like "touch time" or at least is time spent with the physician.

Locke, MD

http://www.patienteducationcenter.org/aspx/news/news_detail.aspx?newsid=310

The relationship between (1) patients' wait time, (2) cycle time—the patient visit from start to finish, (3) 'touch time' [time with clinician], and (4) patient's overall experience. Using the Institute for Healthcare Improvement benchmark of cycle time being equal to 1.5x wait time, the study revealed a broad range of cycle times, wait times, and encounter times across all practices and individual clinicians and practices. The benchmark patient cycle time was 30 minutes, based on an average "touch time" of 20 minutes for the study. It is interesting to note from this study that the strongest correlation between the variables was between the patient's overall experience and the "touch time" with the provider.

http://www.ihi.org/IHI/Topics/OfficePractices/Access/Measures/Office+visit+cycle+time.htm

Office Visit Cycle Time

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.

Related ToolsStandard Room Stocking Checklist ExampleUnplanned Activity Card Rooming Criteria ExamplePatient Cycle Tool

Related ChangesCreate Contingency PlansOptimize the Care Team

Sample Graph

Use Improvement Tracker to enter, save, and graph yourteam's data

http://www.transformed.com/workingPapers/ReducingCycleTime.pdf

Quick Tips for Reducing Patient Cycle Time

By Elaine M. Skoch, RN, MN, CNAA, EMBA and Marly McMillen, MBA

Patient cycle time is the amount of time in minutes that a patient spends in an

office visit, beginning at the time of arrival and ending when the patient leaves

the office. National benchmarks indicate 30 minutes or 1.5 times the actual

“touch time” are target goals for patient cycle time in a practice. (IHI) How can

you do this in your practice? Here are some quick tips!

o Start your day on time! This means being ready for the first patient at the

appointed time. “Being ready” includes:

• Pull charts and review information for scheduled visits, at a minimum, a

couple days before the appointment;

• Assemble reports and information necessary for the visit;

• Contact the patient to identify and schedule lab work etc. to be

performed before the visit;

• Chart information should be available and reviewed prior to entering the

exam room;

• Any necessary imaging and lab work should be returned and reviewed

prior to the visit;

• The patient should be checked in, roomed and prepared for the exam,

including the following.

 Weight and vital signs taken;

 Patient is appropriately gowned;

 Tools required to perform the examination are laid out and ready to be

used.

o Keep the scheduling process simple by limiting the number of types of clinic

appointments. In our study we found that those practices using more than

two types of visit times experienced more difficulty staying on schedule. A

practice offering one short (10 or 15 minute) visit and one long (20 or 30

minute) visit seemed to work best.

o Be “patient centered” even in your scheduling by taking the patient’s needs

into consideration. Some need a short appointment early in the day whereas

others who have multiple conditions may need a longer appointment later in

the day.

o Providers should not try to do it all. “Team care” maximizes the use of skill sets

and experience of all the team members. Nursing staff can provide patient

education and certain laboratory procedures and referrals while mid-levels

can perform follow-up visits for clients with controlled chronic conditions.

o Improve practice processes by periodically performing patient process

observations. Conducting process observations will assist the practice in

eliminating inefficiencies and procedures which are too time consuming and

aid in streamlining care processes. Look at your office through your patient’s

eyes. Are there extra steps in the process that can be eliminated, like moving

the scales closer to where the patients check in? Do you have to leave the

exam room to get patient education information?

o Don’t lose valuable patient “care time” by looking for exam tools or supplies.

Standardize the placement of these items in each patient exam room to

minimize the time spent looking for these items and to ensure each room has

the proper exam tools (reflex hammers, tuning forks, slides, etc.), patient

education materials, and care supplies (cotton balls, bandages, swabs, etc.).

Additional resources:

Find out more about TransforMED's National Demonstration Project (NDP)

http://www.transformed.com/ndp.cfm

Learn about the TransforMED Medical Home model

http://www.transformed.com/transformed.cfm

Read relevant TransforMED workingpapers:

Touch Time Tips

http://www.transformed.com/workingPapers/TouchTimeTips.pdf

Improving the Patient's Experience

http://www.transformed.com/workingPapers/ImprovingPatientExperience.pdf

Huddles: Increased Efficiency in Mere Minutes a Day

http://www.transformed.com/workingPapers/Huddles.pdf