Implementing a Workflow that Decreases Patient Wait Time, Improves the Patient/Family Experience, and Increases Teamwork in a Pediatric Cardiology Clinic Performing Multiple Diagnostic Services

Over the last decade, the cardiology clinic has experienced exponential growth in patient volumes and an increase in the complexity of patients. Cardiology clinic visits often entail performance of multiple diagnostic studies and multiple hand-off points between providers. Because of these complexities, it is challenging to move patients through their visit in a timely and efficient manner.
In Spring 2023, a team of multidisciplinary key stakeholders set out to redesign clinic flow to decrease patient wait times and increase team satisfaction. Baseline time studies indicated patients were spending 40% of their visit waiting and discussions with staff revealed they felt siloed with strained team communication.
Focusing on improving team dynamics, relationships, and communication were a top priority of this new workflow, with an outcome measure being reduction of patient wait time by 46% from a baseline median wait time of 37 minutes. It was anticipated that the implications of improving efficiencies in clinic would allow better utilization of resources, which would increase patient volumes and improve team culture. A standardized and simplified workflow was developed providing clarification of roles, prioritizing face-to-face handoff, and relocating teams for proximity. Addition of a “navigator” staff position allowed for improved patient experience and flow. This role is responsible for regulating visit starts, escorting patients to the next phase of their visit, and facilitating face-to-face handoff with the next caregiver. Care teams were relocated to sit in closer proximity to promote communication and aid in discussions for planning patient needs.
This new workflow was implemented in Summer 2023. Data from the first year shows a significant reduction in patient wait time, with a median wait time of 11 minutes (decrease of 70.2% from baseline median wait time). Patient throughput has increased because of efficiency, with volumes up 10.7% year to date compared to 2023 and access to next available appointment time improved from 103 days to 27 days. Staff, providers, and families reported positive feedback including increased face-to-face handoff communication, team camaraderie, and awareness of patient needs. Prioritizing team dynamics amongst the multidisciplinary leadership team had significant impact in building a model that is sustainable and in support of each individual team. Additionally, modeling and encouraging these behaviors amongst the larger team has facilitated a shift in the team culture.
Lessons learned from the design and application of this model include identifying and including key stakeholders in the process, ensuring active change management occurs, and meeting frequently to assess progress and make adjustments as necessary. Additional takeaways include creating forums to receive timely feedback from staff and providing transparency to team members, including results of data collection and modifications made based on feedback received.
At the end of the session, the learner will be able to discuss this innovative care model implemented to decrease patient wait times and improve the patient/family experience. This structured workflow process change has allowed flexibility with multiple diagnostic services within one visit while increasing predictability for team members, improving communication across job roles, improving the patient/family experience, and increasing patient throughput.