203574 IMPROVING Patient Flow In Pediatric Community Health Center In the District of Columbia

Monday, November 9, 2009

John D. Norman, MHSA , Golberg Center Community Pediatrics, Children's National Medical Center, Washington, DC
Rhonique Harris, MD, MHA , FAAP , Goldberg Center of Community Pediatrics/ Child Health Advocacy Institute, Children's National Medical Center, Washington, DC

The study was initiated to assess patient flow and identity areas of quality improvement.


The target population is the pediatric patients seen by the pediatric community center

Project Description

In the practice there were multiple visit types; walk in sick, prescreen for foster care placement, EPSDT visits, and scheduled sick visits. It was noted that the patient had various points of contact; registration, triage, waiting to see the doctor in the waiting room or in the patient room, face to face contact with the physician, procedures with the nursing and discharge. For all visit types, each point of contact was assessed using a stop clock to document start and finish for all types of visits. The data was collected and analyzed to determine where there can be improvements in patient flow.


For two months during the busy summer season, the patient flow was assessed. Length of time at each point of encounter was tabulated and plotted. The numbers were analyzed based on visit type, duration of visit, and duration of each point of encounter. Once the data was plotted in comparison format, the QI team met to assess the data and determine interventions that would improve patient flow.


The average time spent in the health center was 1:46. There were a couple of extreme visit durations totaling over three hours. The data showed that the longest duration of the visits, when delineated by point of encounter, was during the administrative sign in time period and period waiting to be seen by the physician; 22 and 30 minutes respectively. Surprisingly, the data also showed that the average time spent face to face with a physician did not vary despite the fact that EPSDT and foster care prescreen visits were expected to have different levels of complexity.

Learning Objectives:
Objectives: • To assess and survey patient visit cycle from beginning to the end of the patient visit • Formulate a monitoring system that tracks patient activities and duration for each phase of their visit • Identify best practices, and areas of improvements in the patient flow process that will elicit a reduction in wait times, and improve patient satisfaction • Perform a comparison analysis after implementation to determine the extent of improvements, and recommendations for any additional changes.

Keywords: Pediatrics, Quality of Care

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: Have over 8 years experience managing Health systems, and measuring best practices and efficiencies. Completed Bachelor’s degree in Business Administration and a Master's degree in Healthcare Administration-management. I have presented similar studies in The American Pediatric Association Conference in 2008 and NACHRI in 2009. Design, and implemented the evaluation tools, and performed the primary analysis of this study.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.