Measuring Office Visit Cycle Time

By Tom Ludwig, RN, MBA, FACMPE

Does your practice receive patient complaints about long waits during the visit? Do you have a physician who is constantly behind schedule? Prolonged waiting times affect your practice in several ways. Patients can become dissatisfied to the point of leaving your practice. Physicians and staff become frustrated with delays that can result in long hours and patient complaints.

There are a variety of reasons for prolonged waiting times. Patients who arrive late, staff who take too much time with patients, providers who try to do too many things at once, and poor communication within the office are just a few of the many possible causes. Are you not sure where the problem lies in your practice? It might be time to measure your office visit cycle time.

According to the Institute for Healthcare Improvement (IHI),  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.” Measuring the office visit cycle time can help you identify where the bottlenecks exist in your practice.

When measuring cycle time, you can measure as few or as many steps in the patient visit process as you wish. The fewer steps you measure, the easier it is – but you get less information. The more steps you measure, the more helpful your information will be – but it will also be more resource-intensive. The steps you will want to consider are:

• Patient appointment time
• Time patient checks in at desk
• Time patient is taken to exam room by staff
• Time staff leaves the room
• Time provider enters the room
• Time provider leaves the room
• Time patient leaves the room
• Time patient checks out at desk

IHI recommends that you measure a total of 15 patients in order to get a good average cycle time. The patients should also be measured on the same day of the week and at the same time of the day. Depending on your specialty – or where you think your bottlenecks are – you might also want to include lab, x-ray, or certain procedures in your cycle time measurement.

Cycle time can be measured manually or, depending on the sophistication of your electronic health record (EHR), automatically. The manual method can be done by staff or by patients. A sample form can be found at IHI’s web site, www.ihi.org. Patient Cycle Tool If you prefer to try to automate it, many EHRs are able to time-stamp several important steps in the cycle: patient check-in, staff logging in and out of the record, providers logging in and out of the record, and the end of the visit (closing the encounter).

Once you’ve identified where the bottleneck exists, focus on that step in the cycle and use basic process improvement tools (process mapping, plan-do-study-act cycle) to make changes that will improve your cycle time.

When measuring cycle time for the first time in your practice, you should consider doing several (if not all) of your providers. This will not only enable you to get an overall average for your practice, but you can also identify best performers within your practice and use them as a model for the others. As for a standard benchmark, IHI suggests that you take the amount of time that a patient spends with the provider and multiply that by 1.5. For example, if a patient spends 20 minutes with the provider, the ideal cycle time would be 30 minutes (20 x 1.5 = 30).

Improving patient cycle time can help reduce waiting times in your practice. It can become a valuable aspect of your practice’s quality program. It not only makes the practice more efficient, it is also a great satisfier to patients, staff and providers.

© 2011 Efficiency in Practice

Tom Ludwig is President and CEO of Forward Healthcare Solutions, LLC, a consulting firm that specializes in working with physician practices. Tom has worked in the physician practice setting for a variety of organizations for 35 years. He has extensive experience in clinic operations management with expertise in strategic and business planning, process improvement and workflow efficiency, advanced access, supervisory training and leadership development. Tom can be reached at tludwig@forwardhealthcaresolutions.com or http://forwardhealthcaresolutions.com/index.html

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