Increasing Throughput in the BMT Clinic Setting

In 2016, the Outpatient Bone Marrow Transplant Clinic at UNC initiated a Good Catch (GC) Program aimed at process improvement and increasing efficiency in clinic throughput. This clinic offers transplant patients phlebotomy services prior to provider appointments. However, as recommended during the Epic EMR build, no separate appointment for phlebotomy was created and patients were instructed to arrive 45 minutes early to their provider visit for phlebotomy with labs being drawn in the order of patient arrival (i.e. first come, first served). One project designed by the GC Program included creating a Lab appointment to bridge the patient from the waiting room to exam room. Lab appointments were created in 15 minute intervals, scheduled between 15 and 45 minutes prior to the provider visit. Patients were notified by phone and letters stating the lab appointment arrival time and instructed to arrive 30 minutes prior to the first scheduled appointment. A timed study was conducted over a two week interval (pre-lab appointment) creation (Pre) and also during a two week interval one month post-lab appointment existence (Post). The number of provider visits with phlebotomy during the two week intervals were similar (Pre = 181, Post = 191). Data points were collected for patients at multiple times during a traditional clinic visit, including check-in to first appointment time, patient appointment time to exam room, exam room to check-out, and mediation duration from check-in to check-out. The data was reported and extracted through EPIC via location management, tracking patient movement through the clinic. The duration of time between appointment check-in to phlebotomy, check-in to in exam room, and phlebotomy time to exam room did not differ between Pre and Post cohorts (Table 1). However, the median duration of time in the exam room and the overall median duration of time from check-in until check-out was decreased by a median of 17 minutes and 12.5 minutes respectively.Table 1Pre6/1/16-6/14/16N = 181Post8/17/16-8/31/16N = 191P-ValueCheck-in to Phlebotomy, median (range), minutes3(1-355)3(1-200)NSCheck-in to Exam Room, median (range), minutes36(4-253)36(6-268)NSPhlebotomy to Exam Room, median (range), minutes31(4-163)32(5-164)NSExam Room to Check-Out, median (range), minutes90(17-448)73(12-323).02Check-in to Check-Out, median (range), minutes131.5(42-448)119(38-553).05 Open table in a new tab Overall, patient throughput/wait time in clinic was found to have an inverse relationship after implementing Lab Only appointments. This process change has produced positive feedback from the perspective of clinic flow and will provide an opportunity for future projects within the clinic phlebotomy area. More importantly, it allows our patients to spend less time in a medical facility and more time with family and friends.