Affiliations: [a] Massachusetts General Hospital (MGH) – Institute for Technology Assessment, Boston, MA, USA | [b] MGH Everett Family Care, Boston, MA, USA | [c] Massachusetts General Hospital, Boston, MA, USA
Correspondence:
[*]
Address for correspondence: James E. Stahl, MD, CM, MPH, MGH – Institute for Technology Assessment, 101 Merrimac St, 10th floor, Boston, MA 02114, USA. Tel.: +1 617 724 4447; Fax: +1 617 726 9414; E-mail: jstahl@partners.org.
Abstract: Introduction:Objectively measuring the effect of primary care process interventions is very challenging. Real time location systems (RTLS) hold the potential to solve this problem. Methods:An outpatient clinic was outfitted with a RTLS based on active-RFID (radiofrequency identification). Staff and patients volunteered to wear RFID transponders which unobtrusively recorded time and location. Wearers were identified only by their role: Patient, MA, RN, MD. The clinical process intervention consisted of reorganizing how medical assistants were utilized from a ad hoc common pool of medical assistants to dedicated assignment of medical assistants. Process measures were recorded before, during and after the intervention. Results:230 unique patient encounters were recorded from October 2009–January 2010. Eight MDs, 7 MA and 6 RNs participated. Total flow time was significantly decreased while waiting room time was increased. Variance was significantly reduced for both total flow time and face time. In-room wait time and patient face time were decreased, though this did not reach statistical significance. Conclusion:Objectively measuring process change in primary care is feasible using RTLS. In this case the intervention resulted in the waiting room being used more effectively as a process buffer smoothing flow and potentially increasing clinic capacity.
Keywords: Primary care, RFID, Real-time location systems, process improvement, operations research
