Case: University Health Services: Walk-In Clinic
Case: University Health Services: Walk-In Clinic
Kathryn Angel has been hired as assistant director for ambulatory care at Harvard’s University Health Services. By implementing a triage system, she wanted to reorganize the Walk-In Clinic.
The staff of the clinic includes 22 physicians, 2 registered nurses and 11 nurse practitioners.
Physicians : 40 hours per week, in blocks of three to four hours; in total 150 hours per week available to the Walk-In Clinic
12 hours in Walk-In Clinic
16 hours meeting patients by appointment (including 2 half-hour periods ‘reserve time’)
5 on duty at the UHS infirmary
7 on administrative and other matters
Registered nurse: eight-hour shifts, including one hour for lunch, can treat minor ailments without consulting a physician
Nurse practitioner: eight-hour shifts, 45% of their ours are available to treat patients in the Walk-In Clinic
Before the triage system
There was a lot of dissatisfaction due to the long waiting time between sign-in and treatment (in average 23 minutes). The image of the clinic was cold, inefficient and impersonal. Patients who requested specific physician had to wait an average of 40 minutes. If a nurse had to refer a patient to a doctor, the patient had to wait an average of 10 minutes to meet the doctor. The bottleneck was that all the nurses had to see all the patients initially, which led to inconsistency, too much variation in treatment and duplicated efforts.
The triage system
When the patient arrives, he/she has to fill in an Ambulatory Visit Form (AVF). A triage coordinator (highly experienced registered nurse) calls for the patient and spent 3 or 4 minutes per patient in a private room to summarize the patient’s problem. Then the triage coordinator determines whether the patient need to see a nurse practitioner or a physician, or whether the patient could handled better in another UHS service. Only if the patients their ailments fall under one of 13 categories, they can be triaged to
Kathryn Angel has been hired as assistant director for ambulatory care at Harvard’s University Health Services. By implementing a triage system, she wanted to reorganize the Walk-In Clinic.
The staff of the clinic includes 22 physicians, 2 registered nurses and 11 nurse practitioners.
Physicians : 40 hours per week, in blocks of three to four hours; in total 150 hours per week available to the Walk-In Clinic
12 hours in Walk-In Clinic
16 hours meeting patients by appointment (including 2 half-hour periods ‘reserve time’)
5 on duty at the UHS infirmary
7 on administrative and other matters
Registered nurse: eight-hour shifts, including one hour for lunch, can treat minor ailments without consulting a physician
Nurse practitioner: eight-hour shifts, 45% of their ours are available to treat patients in the Walk-In Clinic
Before the triage system
There was a lot of dissatisfaction due to the long waiting time between sign-in and treatment (in average 23 minutes). The image of the clinic was cold, inefficient and impersonal. Patients who requested specific physician had to wait an average of 40 minutes. If a nurse had to refer a patient to a doctor, the patient had to wait an average of 10 minutes to meet the doctor. The bottleneck was that all the nurses had to see all the patients initially, which led to inconsistency, too much variation in treatment and duplicated efforts.
The triage system
When the patient arrives, he/she has to fill in an Ambulatory Visit Form (AVF). A triage coordinator (highly experienced registered nurse) calls for the patient and spent 3 or 4 minutes per patient in a private room to summarize the patient’s problem. Then the triage coordinator determines whether the patient need to see a nurse practitioner or a physician, or whether the patient could handled better in another UHS service. Only if the patients their ailments fall under one of 13 categories, they can be triaged to