Pre-Processing May Reduce Patient Delays In Medical Education Settings

Chester G. Chambers PhD Armstrong Institute for Patient Safety and Quality Johns Hopkins Carey Business School, Baltimore, Maryland MedicalResearch.com Interview with:
Chester G. Chambers PhD
Armstrong Institute for Patient Safety and Quality
Johns Hopkins Carey Business School, Baltimore, Maryland

Medical Research: What are the main findings of the study?

Dr. Chambers: The main findings of this study are that several metrics of system performance can be improved by using simple methods proven to be effective in many production settings.

Specifically, the idea of using “Pre-processing” as an aspect of medical education improves patient flow times, waiting times, system throughput, and system capacity.

When fixed costs are spread across more patients, we are effectively reducing the cost per patient as well.

In this context “Pre-processing” simply refers to the practice of having medical trainees present and review cases with the attending prior to patient clinic visits as opposed to doing it in the midst of the patient visit. This simple idea is common in many areas including surgery but tends to get omitted in other settings involving ambulatory care. Our simple experiment verified that this practice has real value in a wide array of settings.

Medical Research: What was most surprising about the results?

Dr. Chambers: Our pilot study focused on easily measurable improvements in metrics such as flow times and waiting times. However, we also noted that both trainees and attending physicians felt more comfortable and confident when dealing with patients after the pre-processing meeting. Trianees and Attendings also reported anecdotally that the educational experience was enhanced by the structured sessions done before the start of the clinic session. A larger study is needed to quantify these effects, however, it seems clear that patient care is enhanced through this process even though that was not what we could measure directly.

Medical Research: What should clinicians and patients take away from your report?

Dr. Chambers: Many settings in medical education call for trainees to pre-process cases. Sometimes this takes the form of presenting cases to an attending or a chief resident. In the midst of a chaotic day, it is easy to think that skipping this step leads to quicker results. Our findings suggests that the opposite is actually the case. The use of protocols for case presentation and the dedication of a window of time to do it actually leads to a much smoother flow later in the day. This type of discipline reduces stress, increases quality, and improves flow. We can work smarter, to achieve what we do not achieve by simply trying to work harder.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Chambers: Larger studies are needed to add three elements to the analysis: patient satisfaction, trainee retention of information, and optimization of the pre-processing step. Once these elements are verified, it will be easier to spread these insights throughout the medical systems. Simple approaches focused on measurable outcomes, can have ancillary benefits that are much more important than the most obvious outcomes.

Citation:

Applying JIT Principles to Resident Education to Reduce Patient Delays: A Pilot Study in an Academic Medical Center Pain Clinic

Williams, K. A., Chambers, C. G., Dada, M., Christo, P. J., Hough, D., Aron, R. and Ulatowski, J. A. (2014), Applying JIT Principles to Resident Education to Reduce Patient Delays: A Pilot Study in an Academic Medical Center Pain Clinic. Pain Medicine. doi: 10.1111/pme.12543