Use of a time-flow study to improve patient waiting times at an inner-city academic pediatric practice

Objectives: To use findings from a time-flow study at an academic pediatric practice to restructure practice patterns and to repeat the time-flow study to evaluate consequent changes in patient waiting times, total visit times, and room and nursing time usage rates. Design: A before-and-after time-flow evaluation of patient waiting times, total visit times, and room and nursing time usage rates. Setting: An inner-city academic pediatric practice located at a community health center affiliated with a major urban academic teaching hospital. Patients: All patients visiting the pediatric practice during the weeks of April 26 through 30, 1999, and March 24 through 28, 2000. Interventions: Initial time-flow findings generated in telephone messaging, provider scheduling, nursing location, and provider and preceptor documentation. Main Outcome Measures: Patient waiting times, total visit times, room usage rates, and nursing time usage rates. Results: After the implementing of practice changes, mean total visit time declined from 91.9 to 78.3 minutes. Mean waiting time to be called by the nurse decreased 3.2 minutes, mean time spent with the provider decreased 4.6 minutes, and mean time to wait for a preceptor decreased by 8.8 minutes. Multivariate analysis controlling for visit type, provider type, and the type of postvisit interventions found that mean time of visit decreased by 13.6 minutes. Room and nursing time usage rates, resident satisfaction, and quality-of-care indicators remained largely unchanged. Conclusions: Time-flow studies can be useful instruments for academic ambulatory practices to identify and ameliorate practice inefficiencies without sacrificing quality of teaching or patient care.