The following has been submitted by a colleague in Ontario and describes the layout and configuration of a new practice that has been established to bring a number of smaller groups of physicians together in a shared care setting.
"The practice is designed to be a very open space with shared work "pods" where the physicians and nurses spend most of their day. The pods have 8 workstations that are used by physicians, nurses, our usher who moves patients around and residents when they are there. There is never more than 4 docs for the 12 rooms on one pod and we have 2 identical pods on each side of the building. Our offices are shared between 2 physicians since we end out spending very little time there. The physicians never have less than 3 examination rooms to work with at any time, so this makes for good throughput of patients - very efficient and quick. Our wait time is under 10 minutes for patients as a result of this (in fact we are usually ahead of schedule during the day) We have 90 workstations and about 60 printers so no one waits for a workstation or walks to get what they printed.
There are 24 identical examination rooms (12 per pod), 2 large treatment/emergency rooms, 2 nursing areas that can allow 3 nurses to work at once per pod We have about 10 offices for allied health professional and are starting to hire. We have just brought on a PHD in kinesiology as a health educator for our patients and as well to start our cardiovascular risk management program and do our research. We have our own ambulatory BP monitors and will be getting Holter monitors exclusively for our patients. EKG, PFT, and ambulatory BP are all integrated into our EMR.
We have a total of 14,850 square feet and occupy 55% of the whole building. Overall we are happy and have been able to let in 500 new patients since we moved (December 20, 2007) without adding any physicians or any additional hours of work. We are actually allowing people to call in every 6 weeks or so to get a spot on a first call basis and close the lines at 250. Once these patients are signed up and appointments are given we assess our capacity to take on new patients.
On a good day we see just under 400 patients and at most we have had about a dozen patients at any one time in the waiting room with 8 docs and 5 nurses working. Although I suspected that space was a big limiting factor in the whole improvement process, I never realized exactly how important it was. We are using the same EMR in the same way as we did for the last 2 years and in the past we often had one hour wait times in the waiting room and could not even dream of taking on new patients.
My final conclusion is that EMR's alone are not enough to make a difference and as much effort and investment needs to be made into the space to make real differences!"
This is an example of an efficient practice redesign. The evidence can be seen in the new practice layout and the ability to open capacity and reduce wait times while increasing physician satisfaction.
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