Beruflich Dokumente
Kultur Dokumente
NewBuildingPatientFlow
UnitedStates
GroupPractice
Aim:ReducetheRiskPriorityNumber(RPN)forthePatientFlowandWaitTimeinournewbuildingby10%in4months.
ProcessData
Date:03/24/2008
Step
Description
PatientTelephoneCalltoScheduleAppointment
FailureMode
Causes
Patientkeptonhold,lostcall, Operatorisoverwhelmed,
unansweredphone,closed
Poorlytrainedstaff,unclear
forlunch,wrongextension.
jobdescriptionand
proceduralguidelines.
Multipletypesofofficephone
callsenteringononeline:
"Push#2for???"
Effects
FrustratedPatient/Staff.
Improperscheduling.Hectic
officeroutine:"Somebody
scheduleline2!"Disrupted
officeflow.
Step
Description
ReviewPatientAppointmentHistories,PatientandAccountStatus.
10
280 DedicatedPersonneland
phonelineforappointment
scheduling:nofiltering,that
isrollinglinestomultiple
unrelatedworkstations.
Maintaininghighlytrained
anddedicatedScheduler
withclearprocedures
outlinedandadequate
staffing.
FailureMode
Causes
Effects
IfPatienthasanerratic
schedulinghistoryasin
ReschedulesorNoShows,
theymustberemindedofthe
Cancellations/NoShowPolicy
andtheconsequencesofnot
arrivingontheexpectedday
andtime.
Noncompliantpatient
(Dangerous).
Elderly/forgetfulpatient.Lack
ofcommunicationbetween
caregiver/transportationand
patient.
Delaysinseeingother
patients.DisruptioninOffice
RoutineandSchedule.
LoweredIncomeand
Productivityfromstaff.
Disgruntledstaff.Trendsare
veryimportanttoobserve
anddealwithatalllevels.
45 Clearandexplicitguidelines
fornoncompliancemustbe
communicatedinwritingas
handoutstopatients,posted
policyinofficeandverbally
addressedduringallrelevant
conversationsbyallstaff
includingandespeciallythe
physicians.
AccountStatusreviewis
necessaryforidentifying
noncompliantpatients.The
patientwithagoodpayment
historywillreflectthesame
behaviortowardsmedical
compliance.Makepayment
arrangementsandkeeping
themuptodate.
Noknowledgeofoutstanding
accountbalance,poorpatient
information.Lowincome
level.Embarrassedto
addresstheissue.Billing
mistakesnotthepatients
fault.
Increasedpatientstressand
noncompliance.Disruptionof
officeroutineandschedule.
Lostincome.
48 APatientElectronicdatabase
thatisaccurateandupto
datewithcompleteand
concisePatientappointment
andaccounthistoryavailable
toadedicatedappointment
scheduler.
Patientisnotactive.Doesnot
havePCPorisassignedto
anotherPCP.Donotaccept
patientsinsurancecoverage.
Patientnotknowledgeableor Poorornoreimbursment.
misinformed.Patientistrying
toreceivetreatmentwithout
fulfillingtheircontractual
responsibilities.
56 APatientElectronicdatabase
thatisaccurateandupto
datewithcompleteand
concisePatientappointment
andaccounthistoryavailable
toadedicatedappointment
scheduler.
Step
Description
SchedulePatient
FailureMode
Causes
Effects
ImproperAppointmenttype.
Lackofclearguidelinesfor
Schedulerforsetting
priorities.Lackofclear
appointmenthistoryavailable
toscheduler.Lackofclear
understandingbypatientas
towhytheyarecalling:"The
Doctorwantsmetocomein."
DisruptedPatientflow.
Disgruntledpatientandstaff.
Lostincome.Doctorspissing
andmoaning.
NotthePatientsPCPornon
participating.
Changeincoverageor
employment.
Nonpaymentanddisrupted
officeschedule.
Step
Description
PatientTelephoneRegistration
FailureMode
Causes
InaccuratePatientFinancial
Information.
Lapsedorchangedcoverage, Possiblenonpayment,
changeinemployment.
especiallyifitisaHMOand
patientisnotassignedto
physician.Rebilling,lost
incomeandinefficientuseof
employeetimeandpoor
moral.
16 Confirmingpatient
informationwithboththe
patientandtheinsurance
company.Electronic
databasethatisaccurate
anduptodatewithcomplete
andconcisePatientmedical,
appointmentandaccount
history.
InaccuratePatientMedical
Information.
Patientnotclearwhythe
"Doctorwantsmetocome
in".Schedulerdoesnotcross
referencepatientmedical
historytoconfirmproper
appointmenttype.
128 Step5,6,and7.Confirming
patientinformationwithboth
thepatientandtheinsurance
company.Electronic
databasethatisaccurate
anduptodatewithcomplete
andconcisePatientmedical,
appointmentandaccount
history.
Step
Description
RunDailyAppointmentConfirmation
Effects
Disruptedofficeflowand
schedule.Lostincome,
unhappypatient/staff.Return
foranunnecessaryvisit.
FailureMode
Causes
Wrongappointmenttype
madeduringcurrentday.
Poorpatientinformation
Disruptedscheduleand
availabletoscheduler.Lack disgruntledpatientsandstaff.
ofpatientknowledge.
Schedulerrushedtomake
appointmentanddidnot
confirmwithmedicalrecords.
Effects
Step
Description
Patient24hourpriortoappointmentreview,MedicalandAccount
Status.
Effects
FailureMode
Causes
Requiredpatientmedical
informationfornextday
appointmentnotonhand,i.e.
Labs,reports,authorizations,
etc.
Breakdownin
Revisit,orwrong
communicationswithother
appointmenttype.
officesorpatient.Requestby
Physicianforinformationnot
followedthroughon.
Accountnotuptodate.
Patientforgot.Noncomplant Lostincome.Disruptedoffice
patient.
signin.
Step
Description
PatientAppointmentreviewbyPhyscianandMedicalAssistantfor
nextdayapptiontment.
FailureMode
Causes
Effects
Physicianandstaffnot
preparedfornextdays
patients.Physicianand
medicalassistantneedto
establishaCarePlanfor
eachpatientdetailingchain
ofeventsoncepatientis
broughtback.
Hecticpatientcare.Staffnot
knowingwhattoexpector
secondguessingwhatthe
physicianhasplanned.
Poorhealthcare,disrupted
officeflow,stressedstaff,
patientexperiencesan
unorganizedanddisrupted
officeandlossesfaithincare
beingprovided.
Step
Description
Requestrequireddocumentation.
FailureMode
Causes
Inadequateorincomplete
documentation.
Forgottenbypatient.Notsent Disgruntledpatientand
fromLab,Ancillaries,etc.
disruptedofficeschedule.
Effects
Step
Description
ConfirmAppointmentDaily.Requestpaymentandremindnon
compliantpatientofCancelationPolicy.
120 Standardized,structured
patientSchedulewithFixed
timeslotsforeachtypeof
visit.Clearunderstandingby
scheduleroftimeframe
requiredforeachtypeof
visit.
60 Reviewofmedicalchecklist
andpatientchartwith
medicalassistantandgain
anyadditionalinformation
physicianrequiresbefore
appointment.Makesure
properstaffingisavailable
fornextday.
96 Properlytrainedstaffwith
clearandspecificjob
descriptions.Checklistfor
recordsrequests.Electronic
databasethatisaccurate
withcompleteandconcise
Patientmedical,appointment
andaccounthistory.
FailureMode
Causes
Accountnotuptodate.
Noknowledgeofoutstanding Lowornoreimbursment
accountbalance,poorpatient
information.Lowincome
level.Embarrassedto
addresstheissue.Billing
mistakesnotthepatients
fault.
Effects
60 APatientElectronicdatabase
thatisaccurateandupto
datewithcompleteand
concisePatientappointment
andaccounthistoryavailable
toadedicatedappointment
scheduler.
CalculatedTotals
TotalRiskPriorityNumberfortheprocess
Occ: LikelihoodofOccurrence(110)
Det: LikelihoodofDetection(110)
NOTE: 1=VerylikelyitWILLbedetected
10=VerylikelyitWILLNOTbedetected
Sev: Severity(110)
RPN:RiskPriorityNumber(OccDetSev)
Annotation
None
1209