{"id":4851,"date":"2016-01-06T00:00:00","date_gmt":"2016-01-06T07:00:00","guid":{"rendered":"https:\/\/www.uchealth.org\/today\/2016\/01\/06\/joint-effort-in-uch-orthopedics-clinic-streamlines-care\/"},"modified":"2022-08-17T14:17:54","modified_gmt":"2022-08-17T20:17:54","slug":"joint-effort-in-uch-orthopedics-clinic-streamlines-care","status":"publish","type":"post","link":"https:\/\/www.uchealth.org\/today\/joint-effort-in-uch-orthopedics-clinic-streamlines-care\/","title":{"rendered":"Joint effort in UCH Orthopedics Clinic streamlines care"},"content":{"rendered":"<div style=\"margin-top: 0px; margin-bottom: 0px;\" class=\"sharethis-inline-share-buttons\" ><\/div><p>A team-based initiative in the Orthopedics Clinic at University of Colorado Hospital has helped slash patient wait times and improve productivity even as clinic volumes have increased significantly.<\/p>\n<p>The positive changes are the result of a process-improvement project initiated with the <a href=\"https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2017\/02\/28144951\/ihqse.pdf\">Institute for Healthcare Quality, Safety and Efficiency<\/a> (IHQSE). The IHQSE, launched three years ago by UCH, the CU School of Medicine and College of Nursing, and Children\u2019s Hospital Colorado, equips staff and providers with training and skills to address operational issues in clinical settings.<\/p>\n<p>The project used time and motion studies conducted in May and October 2015, respectively, to evaluate the effectiveness of changes instituted to improve clinic workflow. Staff time-stamped each step of a patient\u2019s clinic visit, from check-in to check-out, in May, then repeated the process in October. An evaluation of roughly 250 patients in each study showed the changes helped to cut patient wait times in half \u2013 from 31 minutes to 16 minutes. The time providers spent with patients increased by a third, from 24 minutes to 32 minutes. The time patients waited to leave the clinic after their appointments fell by about 80 percent, from 11 minutes to 2 minutes.<\/p>\n<figure id=\"attachment_2425\" aria-describedby=\"caption-attachment-2425\" style=\"width: 300px\" class=\"wp-caption alignright\"><img loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-2425\" src=\"https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/1970\/01\/28144951\/EXT_010616_Ruedeman20and20Nelson-scaled.webp\" alt=\"\" width=\"300\" height=\"200\" srcset=\"https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/1970\/01\/28144951\/EXT_010616_Ruedeman20and20Nelson-scaled.webp 1600w, https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/1970\/01\/28144951\/EXT_010616_Ruedeman20and20Nelson-300x200.webp 300w, https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/1970\/01\/28144951\/EXT_010616_Ruedeman20and20Nelson-1024x683.webp 1024w, https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/1970\/01\/28144951\/EXT_010616_Ruedeman20and20Nelson-768x512.webp 768w, https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/1970\/01\/28144951\/EXT_010616_Ruedeman20and20Nelson-1536x1024.webp 1536w, https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/1970\/01\/28144951\/EXT_010616_Ruedeman20and20Nelson-2048x1365.webp 2048w, https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/1970\/01\/28144951\/EXT_010616_Ruedeman20and20Nelson-150x100.webp 150w, https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/1970\/01\/28144951\/EXT_010616_Ruedeman20and20Nelson-200x133.webp 200w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><figcaption id=\"caption-attachment-2425\" class=\"wp-caption-text\">Daniel Ruedeman, a certified athletic trainer with the Orthopedics Clinic\u2019s trauma team, speaks with Orthopedics Practice Manager Laura Nelson. The two have played a key role in revamping the clinic\u2019s staffing model.<\/figcaption><\/figure>\n<p>The improvements came during a time of substantial clinic growth in patient volume \u2013 roughly 1,000 more clinic visits in 2015 than in 2014 \u2013 and the number of providers, said Laura Nelson, practice manager for the Orthopedics Clinic. The key to success, Nelson said, was \u201ca complete redefinition of the staffing model.\u201d<\/p>\n<p>Certified athletic trainers (ATs) played an important role early on in the process redesign by <a href=\"https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2017\/02\/28144951\/athletic20trainers20md20extenders.pdf\">acting as physician extenders<\/a>. They took on tasks that include coordinating patient care, answering patient questions, providing instructions, discussing plans of care, and completing after-visit summaries. This work helps to free physicians to move on to their next patient and prevent bottlenecks in the clinic.<\/p>\n<p><strong>Team game<\/strong><\/p>\n<p>More broadly, ATs are now one part of subspecialty-based teams <em>(see box)<\/em> that include nurses, medical assistants (MAs), physician assistants (PAs), and physicians. Each has defined roles aimed at maximizing their skills, said Dan Ruedeman, an AT with the trauma team. The assigned tasks may overlap \u2013 performing a history and physical might be handled by either an AT or an MA, for example \u2013 and the specifics vary from team to team. But there are no questions about who can do what for a given patient on a given day, Ruedeman said.<\/p>\n<p>\u201cStaff is more accepting of their roles because they have defined duties,\u201d he said.<\/p>\n<figure id=\"attachment_2426\" aria-describedby=\"caption-attachment-2426\" style=\"width: 219px\" class=\"wp-caption alignleft\"><img loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-2426\" src=\"https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/1970\/01\/28144951\/EXT_010616_Craig20Hogan.webp\" alt=\"\" width=\"219\" height=\"300\" srcset=\"https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/1970\/01\/28144951\/EXT_010616_Craig20Hogan.webp 466w, https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/1970\/01\/28144951\/EXT_010616_Craig20Hogan-219x300.webp 219w, https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/1970\/01\/28144951\/EXT_010616_Craig20Hogan-109x150.webp 109w, https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/1970\/01\/28144951\/EXT_010616_Craig20Hogan-200x274.webp 200w\" sizes=\"auto, (max-width: 219px) 100vw, 219px\" \/><figcaption id=\"caption-attachment-2426\" class=\"wp-caption-text\">Craig Hogan, MD, helped garner provider support for the process-improvement initiative.<\/figcaption><\/figure>\n<p>The collaboration doesn\u2019t end with the clinic-based team, he added. They also work closely with front-desk staff and with schedulers to stay on top of changes in the patient flow, such as walk-ins \u2013 a regular occurrence for Ruedeman\u2019s trauma group.<\/p>\n<p>Outside the walls of the clinic, communication with X-ray is also important, to ensure patients get imaging studies in a timely fashion, Ruedeman said. In addition, Nelson huddles with managers of other clinics on the fourth floor of the Anschutz Outpatient Pavilion (AOP) to plan placing patients in available exam rooms. The overriding aim: avoid wasting patients\u2019 and providers\u2019 time.<\/p>\n<p>\u201cNo matter how many patients we have, the clinic runs smoother because we can adapt on the fly,\u201d Ruedeman said. \u201cWe know where we can put add-on patients, and that improves same-day access. Everything is addressed in a timely fashion.\u201d<\/p>\n<p>The new model has helped the trauma team absorb the addition of two new PAs, each of whom run half-day clinics that see 10 to 18 patients, without sacrificing the quality of care, Ruedeman added.<\/p>\n<p>\u201cWe\u2019re accommodating 20 to 30 more patients in a week than we did before,\u201d he said.<\/p>\n<p><strong>Physician pleaser<\/strong><\/p>\n<p>The increased volume is a plus for providers, said <a href=\"https:\/\/www.cumedicine.us\/providers\/orthopedics\/craig-hogan\">Craig Hogan, MD<\/a>, who sees hip- and knee-replacement patients. Hogan was the first physician in the Orthopedics Clinic to move to the subspecialty-based team model and has helped to promote the idea to his colleagues. There was some initial reluctance to accept a change in the established process, but the efficiency gains \u2013 improved patient access and satisfaction; increased clinic and procedural volume \u2013 quickly overcame that, he said.<\/p>\n<p>\u201cI\u2019ve heard nothing but positive things from providers, and the response from patients has been overwhelmingly positive,\u201d Hogan said.<\/p>\n<p>Hogan, who typically sees 30 patients during his three-quarter-day clinic Wednesdays in the AOP, said he finds the biggest benefit of the new system at the end of the visit. He answers the patient\u2019s questions, then leaves for the next one while his ATC, Katie Forsyth, prepares the after-visit summary, goes over the plan of care, sets up coordinated care, enters Hogan\u2019s orders in Epic, and completes other time-saving tasks.<\/p>\n<p>A two- to three-minute savings per patient quickly adds up, cutting the amount of time Hogan spends after the last patient leaves catching up on his charting and other tasks. \u201cIt\u2019s a significant amount of time saved. At the end of the day there is less work to do,\u201d he said.<\/p>\n<p>Hogan\u2019s support for the change was indispensable to its success, Nelson said. \u201cHe understands the clinic\u2019s needs from a physician\u2019s perspective, but has also worked to problem-solve with staff,\u201d she said. \u201cHe truly understands both sides. The success has taken a team culture, with everyone truly on board. That has taken us through the bumps and the hiccups.\u201d<\/p>\n<hr \/>\n<p><strong>Orthopedics Team Members<\/strong><\/p>\n<p>Sub-specialty teams at UCH:<\/p>\n<ul>\n<li>Adult Reconstruction<\/li>\n<li>Foot and Ankle<\/li>\n<li>Hand<\/li>\n<li>Hip Preservation<\/li>\n<li>Non-operative<\/li>\n<li>Orthopedics<\/li>\n<li>Shoulder<\/li>\n<li>Trauma<\/li>\n<\/ul>\n","protected":false},"excerpt":{"rendered":"<p>A team-based initiative in the Orthopedics Clinic at University of Colorado Hospital has helped slash patient wait times and improve productivity even as clinic volumes have increased significantly. The positive changes are the result of a process-improvement project initiated with the Institute for Healthcare Quality, Safety and Efficiency (IHQSE). The IHQSE, launched three years ago [&hellip;]<\/p>\n","protected":false},"author":2143,"featured_media":2425,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"_relevanssi_hide_post":"","_relevanssi_hide_content":"","_relevanssi_pin_for_all":"","_relevanssi_pin_keywords":"","_relevanssi_unpin_keywords":"","_relevanssi_related_keywords":"","_relevanssi_related_include_ids":"","_relevanssi_related_exclude_ids":"","_relevanssi_related_no_append":"","_relevanssi_related_not_related":"","_relevanssi_related_posts":"","_relevanssi_noindex_reason":"","footnotes":""},"categories":[8],"tags":[335,67,183],"class_list":["post-4851","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-news","tag-anschutz-medical-campus","tag-orthopedic-care","tag-orthopedics"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v27.4 (Yoast SEO v27.4) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>Joint effort in UCH Orthopedics Clinic streamlines care - UCHealth Today<\/title>\n<meta name=\"description\" content=\"A team-based initiative in the Orthopedics Clinic at University of Colorado Hospital has helped slash patient wait times and improve productivity even as clinic volumes have increased significantly. The positive changes are the result of a process-improvement project initiated wi...\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.uchealth.org\/today\/joint-effort-in-uch-orthopedics-clinic-streamlines-care\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Joint effort in UCH Orthopedics Clinic streamlines care\" \/>\n<meta property=\"og:description\" content=\"A team-based initiative in the Orthopedics Clinic at University of Colorado Hospital has helped slash patient wait times and improve productivity even as clinic volumes have increased significantly. The positive changes are the result of a process-improvement project initiated with the Institute for Healthcare Quality, Safety and Efficiency (IHQSE). 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