Crowder, Carly

Greenberg, Marna R, DO, MPH, FACEP

Karakashian, Nikos

Koti, Ajay, MS

Mcfadden, Kathleen

Reinhart, Richelle

English

Lehigh Valley Health Network: LVHN Scholarly Works

Lehigh Valley Health NetworkLVHN Scholarly WorksUSF-LVHN SELECTTechniques to Improve Patient Flow in a PediatricStreet Medicine Clinic.Richelle ReinhartUSF MCOM- LVHN Campus, Richelle.Reinhart@lvhn.orgCarly CrowderUSF MCOM- LVHN Campus, carly.crowder@lvhn.orgNikos KarakashianUSF MCOM- LVHN Campus, nikos.karakashian@lvhn.orgAjay Koti MSUSF MCOM-LVHN Campus, ajay.koti@lvhn.orgKathleen McfaddenUSF MCOM- LVHN Campus, Kathleen.Mcfadden@lvhn.orgSee next page for additional authorsFollow this and additional works at: https://scholarlyworks.lvhn.org/select-programPart of the Medical Education CommonsThis Poster is brought to you for free and open access by LVHN Scholarly Works. It has been accepted for inclusion in LVHN Scholarly Works by anauthorized administrator. For more information, please contact LibraryServices@lvhn.org.Published In/Presented AtReinhart , R. Crowder, C. Karakashian, N. Koti, A. McFadden, K. Greenberg, M. (2017, March). Techniques to Improve Patient Flow ina Pediatric Street Medicine Clinic. Poster Presented at: 2017 SELECT Capstone Posters and Presentations Day. Kasych Family Pavilon,Lehigh Valley Health Network, Allentown, PA.AuthorsRichelle Reinhart; Carly Crowder; Nikos Karakashian; Ajay Koti MS; Kathleen Mcfadden; and Marna R.Greenberg DO, MPH, FACEPThis poster is available at LVHN Scholarly Works: https://scholarlyworks.lvhn.org/select-program/157BACKGROUND© 2017 Lehigh Valley Health Network•  Valley Youth House (VYH) is a non-profit organization that acts as a temporary shelter for homeless and displaced teenagers in the local community in Northeastern Pennsylvania. •  The Street Medicine program at LVHN and USF 4th year medical students have created a clinic at VYH to perform state-mandated intake physical exams. •  The unique nature of street medicine does not often lend itself to the typical structure of a clinic. There was no organized approach to patient flow through the clinic, resulting in 0% of the EMR charts being completed by the end of clinic.AIM STATEMENTClinic Flow Map PROJECT DESIGNThis quality improvement (QI) project follows kaizen principles, with many changes impacting patient flow executed over the past year (implementation of the clinic in March 2015). A multidisciplinary team worked together to design the changes, including medical students, a variety of specialists (Emergency Medicine, Ob/Gyn, Pediatrics, Internal Med), VYH leadership, patients, and staff. MEASURES•  Patients were timed moving through different parts of the clinic: vitals acquisition, history & physical with medical student, precepting time between attending and student, history & physical with attending, and documentation time.•  Outcome measures included the number of charts completed and the time after clinic that they were closed (the same night, within 1 day, within 1 week)•  Flow of clinic was observed subjectively to assess successes and areas of improvementCHANGES MADE1.   A standardized work process was implemented to maximize efficiency in training leadership and volunteers2.   A manual was constructed for transition of student leadership3.   Positions with specific job indications were created    •  Flow and Vitals Student Director4.   Time limits for certain areas of the clinic were implemented5.   Standardized work tools were used 6.   Based on spaghetti maps and process analysis, a third room was added7.   A board with patient locators was made to direct volunteers8.   MS4 teaching role was establishedOUTCOMESThe number of EMR charts completed by the end of clinic increased from 0% to 100%. The time for completing histories and physicals by students decreased from an average of 27 minutes to 20.2 minutes, a reduction of 25%.CONCLUSIONS•  This project has ended in a sustainable model for both street medicine and student-run clinics.•  Transition of leadership successfully took place in August 2016. •  There is not a breadth of data regarding how to maintain a street medicine or student-run clinic, therefore others who are interested in improving their clinics may benefit from our model.•  These improvements allowed practitioners to more efficiently see patients, likely improving the experience patients have and allowing for more time for education and discussion among learners.Preformed H&P setsCommunication with VYH staffMS4 documentation in roomAlarm for timingLESSONS LEARNEDA street medicine and student clinic is unlike other environments that have been more traditionally studied. Improving the flow of this clinic has taken many reiterations of the process and involves feedback from all of those involved. Our current structure has allowed for more efficient flow of patients, concentration on education during the visit, and improved use of physician’s and students’ time. 45%17%20%17%Proportion of Patient's Time Spent with Team MemberVitalsWaitingAttendingStudent1517192123252729Time (minutes)Clinic DatesTimes for H&P CompletionRun ChartPDSAFlow director orients volunteersVitals director begins assessing VS1st two pts are roomed and seen by medical studentsFlow director knocks at 15 and 20 minutesStudent precepts with attendingAttending sees patientDocumentation completedFlow director knocks at 10 minutesVitals director sees acute and extra patientsClinic Flow MapFUTURE STEPSAs this is a PDSA project, there are still changes being implemented in the current model of the clinic. After each clinic day, time is taken to “check out” and discuss successes and available areas for improvement. We anticipate that as the new student directors and volunteers become accustomed to their roles, the flow of patients will continue to improve.Clinic Date # Charts Same Day 1 Day 1 Week 9/3/15 7 0 3 09/17/15 3 0 0 010/1/15 5 0 0 512/17/15 4 0 4 09/1/16 5 5 0 010/6/16 6 6 0 0Lehigh Valley Health Network, Allentown, PATechniques to Improve Patient Flow in a Pediatric Street Medicine ClinicRichelle Reinhart, Carly Crowder, Nikos Karakashian, Ajay Koti, Kathleen McFadden,Marna Greenberg DO, MPHTo increase the number of completed patient charts within 1 day from March 2015 to December 2016 to 75%. 

Techniques to Improve Patient Flow in a Pediatric Street Medicine Clinic.

https://scholarlyworks.lvhn.org/cgi/viewcontent.cgi?article=1165&context=select-program

Techniques to Improve Patient Flow in a Pediatric Street Medicine Clinic.

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