During my sophomore year of college as a pre-med, I volunteered at the front desk of a free clinic, where it was typical to see patients waiting sometimes for more than two hours. At first I figured it was just because some patients took longer to examine than others. It wasn’t until I got certified as a nurse’s aide and started working in the medical department at the same clinic that I found out what was really going on.
It wasn’t that the doctors were taking longer to examine some patients; it was that the medical staff didn’t always know that they had a patient waiting in the first place.
Our clinic has a pharmacy, dental, mental health and medical department, three of which are managed by the front desk staff. When a medical patient signs in, the receptionist puts the patient’s chart in a bin to let the medical staff know that a patient has arrived. There is no bell, no blinking light, so a nurse would only know when a patient checks in by peeking down the hall every so often to see if a chart is in the bin. The bin was often blocked by hall traffic, closet doors and even carts filled with prescriptions, so the staff wouldn’t see the chart until long after the patient had arrived. And when the front desk couldn’t find the patient’s chart to begin with, the medical staff again wouldn’t know till much later – if at all – that a patient was in the waiting room.
So it was possible that our department wouldn’t realize that someone was patiently waiting to be seen until we cleaned up at the end of the day, after all the doctors had left, and happened to find the lone patient still waiting in the lobby. I felt terrible whenever this happened. They had been waiting for hours, and all we could do was offer to reschedule their appointment.
Ideally, medical staff would peek down the hall at regular intervals, see the chart in the bin, room the patient and put a colored clip on the door of the room. Each doctor had a color, so he or she would know if the room held a patient that was waiting for them. But even after the patient was roomed, it was still possible for doctors to miss their patients.
Once, a physician asked me and another staff member if she had any other patients to see. Since the volunteer nurse who triaged her patients wasn’t present at the moment, we told her that if she didn’t see any rooms marked with a red clip, she was done for the day. However, there was a cabinet next to one of the examination rooms that made it impossible to see the clip from where we were standing. Naturally, we found another patient waiting in that examination room at the end of the day. Again, all the physicians had already left. These kinds of situations occurred so often that I frequently found myself brainstorming ways to check in, room and see our patients more efficiently. I actively monitored the bin to make sure patients were triaged as soon as they came in. I even organized and labeled documents in separate folders to make it easier for the volunteers to triage patients, but this still didn’t fix the core problem.
Finally a light bulb went off at the annual AMSA convention when I heard Dr. Andrew Morris-Singer mention using Google Docs to manage patients more efficiently. This system would be perfect to use at our clinic, I thought. At my next shift, I spoke to a director at the clinic to discuss how we could use a Google Docs to track patients and facilitate easier communication between the front desk and the medical department. The front desk staff would note in the doc that they had checked a patient in, and then the medical staff would see the update to the doc on their own computers at their station. No longer would it be necessary to crane their necks down the hall and squint to see a chart in the bin.
Once I got the okay, I began creating a table that would provide enough information to sign patients in and give the medical staff the entire responsibility of managing the medical charts at all times. After using the Google Docs for just a couple of days, the entire clinic was so impressed. The front desk had no more charts to deal with and the nurses were able to track and manage each patient from the time they walked in to the time they left. The physicians and other staff members also started using the Google Docs as a reference to determine where each patient was instead of searching for colored clips on doors.
After just one week, staff members were telling me how much the new system had improved patient management. And for the first time, patients were telling me “Wow, that was fast!” as I took them to their rooms. I’m relieved that I don’t have to apologize for long waits anymore. And I still can’t believe that as a volunteer, and an undergrad at that, I actually implemented a system that radically changed how our clinic runs, streamlined clinician work flow and improved patient experience. Even though I may not be a physician yet, I can still take part in making a direct improvement in our health care system.
Avanthi Jayaweera is a pre-medical student who blogs at Primary Care Progress.
