Refining Throughput and Patient Satisfaction through the Use of Interprofessional Rounds within a Neurology Clinic

In a neurology clinic within a large academic health system, patients who enter the clinic frequently have medical conditions that make progression through an office visit challenging. Patients may present to the clinic to discuss their impaired memory, movement, or speech abilities. Therefore, this population requires sensitive attention by clinic staff to help them navigate the office visit.

The “moving through the visit” category on Press-Ganey patient satisfaction survey assesses patient response to wait experience during a neurology clinic visit. The mean score for this category on the survey was 86.7% (n=1154) during the pre-intervention quarter (visit date 03/01/18-05/30/18). This percentage falls below the target satisfaction metric of >90%, revealing that the wait process during neurology clinic office visits required revision. A root cause analysis revealed that the communication between clinic staff and patients during waiting periods was not uniform.

According to Cooper (2016), standardized rooming processes are associated with improved patient satisfaction outcomes in the medical office environment. The intervention to improve patient satisfaction with the waiting process was therefore targeted at regulating the times that patients were checked on. Clinic supervisors developed a schedule to round on waiting areas during the times that were identified to have the peak volume of patients. From the waiting area, medical assistants then brought patients back to the exam room as soon as possible upon arrival. Once roomed, medical assistants then rounded on patients in exam rooms every 10 minutes to offer updates on expected remaining wait time, offer assistance ambulating to the restroom, and offer refreshments or entertainment media. The last time the patient had been checked on was then updated on a dry erase board at the medical assistant desk.

In the post-intervention quarter (visit date 06/01/18-08/31/18), all mean Press-Ganey survey scores associated with “moving through the visit” increased as compared to the pre-intervention quarter. Score for information about delays increased 0.7% (n=1015), satisfaction with wait time increased 0.8% (n=1144) and overall “moving through the visit” increased 0.6% (n=1154). Multiple patient survey comments stated appreciation on being checked on regularly and notified of delays (n=135).

Outpatient clinics have less standardization of care as compared to inpatient settings (Bates and Singh, 2018). Current interventions have shown the positive impact of standardizing touchpoints between the patient and staff during the office visit. In order to better track this process, the 10-minute time checks will now be documented in the EMR system. To better serve a population that can benefit from increased assistance during an office visit, the neurology clinic will continue to take strides to improve the process of patients progressing through the clinic.