Using quality improvement methodology to improve clinic flow at a pediatric outpatient clinic
Plimpton, Nicholas Morrill
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Boston Medical Center’s pediatric outpatient clinic has resident clinic flow problems that negatively affect its patient care level. Due to system backup, in August 2012, resident patients spent an average of 71 minutes in the clinic for a scheduled 20-minute appointment. This study used quality improvement methodology (QI) to investigate potential solutions to the clinic flow problems. Our aim was, by May 2013 decrease the average patient time-in-clinic for resident vaccination patients between 2 and 30 months of age by 20%. Using Plan-Do-Study-Act (PDSA) cycles within QI, the research team implemented three interventions between August 2012 and May 2013 that focused on improving communication between members of the clinic medical team. Throughout the year, the research team measured the time-in-clinic for the patient population, plotted the data with run charts, and determined if the interventions resulted in a corresponding decrease in time. By May 2013, the interventions resulted in an average decrease in time across all resident classes. First years showed a 4.5% decrease. Second years showed a 5.7% decrease. Third years showed a 20% decrease. While these decreases are significant, due to time limitations, we could not determine if the interventions resulted in a lasting improvement to clinic flow.