TABLE 1.
Clinic Time and Cost Metrics
| Metrics by Clinic | Cycle Time | In Room to With MD | Waiting Room Time | Rooming Time | Wait for APP | Time With APP | Wait for MD | Time With MD | Wait for RN Wrap Up | Time for RN Wrap Up |
|---|---|---|---|---|---|---|---|---|---|---|
| GI clinic | ||||||||||
| Baseline (n = 485), minutes | 91 (71–114) | 54 (39–72) | 14 (8–26) | 13 (9–18) | 11 (5–20) | 22 (12–32) | 20 (11–13) | 33 (25–48) | – | – |
| After intervention (n = 71), minutes | 72 (52–82) | 47 (33–60) | 5 (3–14) | 12 (9–14) | 5 (3–8) | 19 (22–26) | 6 (3–15) | 23 (15–31) | – | – |
| Time reduction, minutes | 19 | 7 | 9 | 1 | 6 | 3 | 14 | 10 | ||
| Baseline cost, $ | 176 | 9 | 22 | 145 | ||||||
| After intervention cost, $ | 124 | 4 | 19 | 101 | ||||||
| Cost savings, $ | 52 | 5 | 3 | 44 | ||||||
| Genitourinary clinic | ||||||||||
| Baseline (n = 247), minutes | 89 (71–116) | 57 (38–77) | 0 (0–3) | 26 (18–33) | 9 (4–24) | 22 (16–33) | 16 (12–34) | 25 (12–47) | – | – |
| After intervention (n = 205), minutes | 73 (56–95) | 48 (27–60) | 0 (0–9) | 11 (7–16) | 7 (3–14) | 21 (13–31) | 7 (3–16) | 21 (13–31) | 1 (0–4) | 5 (3–13) |
| Time reduction, minutes | 16 | 9 | 0 | 15 | 2 | 1 | 9 | 4 | ||
| Baseline cost, $ | 150 | 19 | 22 | 109 | ||||||
| After intervention cost, $ | 117 | 4 | 21 | 92 | ||||||
| Cost savings, $ | 33 | 15 | 1 | 17 | ||||||
| Thoracic clinic | ||||||||||
| Baseline (n = 345), minutes | 72 (55–93) | 48 (35–63) | 0 (0–2) | 16 (12–24) | 8 (4–14) | 14 (9–19) | 10 (3–18) | 21 (13–33) | 8 (3–13) | 11 (7–17) |
| After intervention (n = 233), minutes | 69 (57–83) | 38 (27–51) | 0 (0–3) | 5 (3–7) | 8 (4–15) | 15 (11–22) | 7 (2–16) | 16 (10–26) | 2 (1–6) | 11 (6–17) |
| Time reduction, minutes | 3 | 10 | 0 | 11 | 0 | −1 | 3 | 5 | 6 | 0 |
| Baseline cost, $ | 125 | 11 | 14 | 92 | 8 | |||||
| After intervention cost, $ | 95 | 2 | 15 | 70 | 8 | |||||
| Cost savings, $ | 30 | 9 | −1 | 22 | 0 | |||||
| Community clinics | ||||||||||
| Baseline (n = 251), minutes | 75 (56–98) | 38 (26–54) | 11 (6–18) | 18 (13–29) | 8 (5–14) | 16 (13–22) | 12 (5–20) | 31 (17–45) | – | – |
| After intervention (n = 725), minutes | 66 (51–82) | 34 (21–48) | 9 (6–16) | 5 (3–9) | 7 (3–15) | 16 (12–26) | 7 (3–15) | 24 (14–35) | 4 (2–8) | 11 (6–17) |
| Time reduction, minutes | 9 | 4 | 2 | 13 | 1 | 0 | 5 | 7 | ||
| Baseline cost, $ | 165 | 13 | 16 | 136 | ||||||
| After intervention cost, $ | 123 | 2 | 16 | 105 | ||||||
| Cost savings, $ | 42 | 11 | 0 | 31 |
NOTE. Numbers are medians (25th to 75th IQRs). Cycle time = from entering examination room until check-out. In room to with MD = time from the patient entering examination room until MD arrival. Base Costs per hour: MA $19.57, RN $42.80, APP $59.94, MD $263.
Abbreviations: APP, advanced practice provider; MA, medical assistant; MD, attending physician; RN, registered nurse; $, US dollars.