Patient Reception - Bursting the Bottleneck
14 November 2012 Last updated:
30 September 2014
Patient Reception – Bursting the Bottleneck
By Vickie Knight, Sydney Sexual Health Centre
At the Sydney Sexual Health Centre, the addition of fast track services had a negative impact on reception of clients, substantially increasing administration staff workload and causing reception bottlenecks.
These bottlenecks increased the length of the patient journey, with patients experiencing long wait times before seeing a clinician.
A Computer-Assisted Self-Interviewing (CASI) system was developed enabling patients to electronically self-register for appointments.
The new system produced reductions in:
- reception process time
- medical record preparation
- registration time.
To reduce the time taken by administration staff to register patients attending the service and therefore improve the patient journey.
In 2010, the Centre reorientated services and introduced a fast track screening service in an effort to reduce long wait times and increase ability to meet demand. Evaluation of this service addition demonstrated that a greater number of patients were seen, the average wait times and length of clinic visits declined, and that clinic capacity increased substantially (Knight et al, in press).
However, redesign also resulted in a substantially increased workload for administration staff, causing bottlenecks at reception. This has increased the patient journey with patients experiencing long wait times before seeing a clinician.
The patient database was reviewed to quantify the increase in patient attendances since introduction of the fast track service:
- 11% more patient visits in the first 5 months after introduction of the fast track service in, 2011
- 39% more patient visits in the first 5 months of 2012
- 37% proportion of new patients in the first half of 2012
- Previous average proportion of new clients per year is 50%
The amount of administrative time taken to register a new client is significantly more than registering a return patient. Therefore, this increase in new patient numbers has significantly impacted on reception workload. The other issue with pen and paper client registrations is errors and omissions of contact details due to illegible hand writing. There has not been an increase in administrative staff hours at the Centre.
Planning and implementing solutions
A multidisciplinary working group was established and reported to the Centres’ Clinical Service Management group.
A literature review showed gains could be made by using computer assisted self interview (CASI) systems to register and arrive patients for appointments.
Patient feedback and satisfaction with using a CASI in the fast track service was assessed and 94% of patients reported being very satisfied so it was thought a CASI at reception would be acceptable also (Martin et al, 2011).
The working group looked at both the technical and administrative requirements of the system and mapped this to the patient journey.
The Data Manager at the Centre built the CASI to run alongside the sexual health operating system already in place, which houses the patient database, appointment system and virtual waiting room.
The registration and self arrival system was trialled by staff who completed the process on a dummy CASI and provided feedback.
The system was then piloted with new patients in order to identify unclear or problematic areas and test the appropriateness of the language used in the CASI.
In order to house the touch screen computers required by the CASI, the reception desk was redesigned and purpose built. The touch screens were mounted under the desk ensuring patient privacy.
The new CASI system went live on the 12th March 2012. Patients with appointments receive an appointment reminder the day before which contains a unique 3 digit code the patient can use to self register.
The new reception process has replaced the old system and is used by all patients attending the service. All staff were trained in use of the new system and all new staff at the Centre are orientated to the process of registration and self arrival. The Centres' standard operating procedure manual was updated to include the new system.
Outcomes and evaluation
Anecdotal feedback from staff and patients is that the system is 'brilliant' and 'efficient' and staff think it has improved the reception process beyond their expectations.
A pre and post redesign time flow study was undertaken. The study collected data on time taken at each stage of the reception process: wait to be served, time to complete the paper registration form, time to data enter the registration form, time to prepare the medical record, and total reception time (time from patient arrival at reception to time the medical record is ready for the clinician).
- The largest gain was made in staff time with an 87% decrease in time taken to prepare the medical record.
- Patients took 38% less time to complete the registration form electronically.
- An unexpected outcome of the redesign was the amount of patients providing better contact details in the CASI.
|Average total reception time||11 minutes||5 minutes|
|Time range for reception||8-18 minutes||4-6 minutes|
Percentage of patients providing postal address
Percentage of patients providing email address
Percentage of abandoned telephone calls from patients
The registration and self arrival system could be used by any outpatient service with large volumes of patients and be either integrated into their electronic patient management systems or used as stand alone modules. We plan to incorporate the system in the youth outreach services conducted by the Centre at Bondi Junction and Maroubra. The system has also been adapted for use at several self STI testing services implemented in non-health facilities in inner Sydney.
Clinical Nurse Consultant
Sydney Sexual Health Centre, Sydney Hospital
Phone: 02 9382 7462
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