title: Anticoagulation clinic workflow analysis.
abstract: OBJECTIVE
  To evaluate a workflow model and define factors affecting patient visit length in an anticoagulation clinic primarily treating an urban patient population.
  
  
  METHODS
  Workflow analysis.
  
  
  METHODS
  Anticoagulation clinic in Memphis, TN, between November 2005 and April 2006.
  
  
  METHODS
  240 and 246 patient visits were assessed pre- and postintervention, respectively.
  
  
  METHODS
  For 7 weeks, pharmacists documented factors affecting visit length and problems addressed during the visit, which were classified as anticoagulation or non-anticoagulation related. Following data analysis, changes were made to address inefficiencies in the clinic workflow. Postintervention data were collected for 7 weeks to assess the impact of these interventions.
  
  
  METHODS
  Patient visit length and factors affecting patient visit length.
  
  
  RESULTS
  Factors affecting visit length were overbooking, pharmacist preceptor availability, attending physician availability, and repeat venipuncture. To target these inefficiencies, changes were made to the clinic schedule and workflow and a patient-provider agreement was implemented. These interventions decreased the frequency of the visit length factors significantly. As a result, pharmacist providers addressed significantly more total problems (anticoagulation problems plus nonanticoagulation problems) without an increase in visit length.
  
  
  CONCLUSIONS
  Periodically evaluating workflow efficiency and making changes, if indicated, is important. In this study, we identified areas for improvement in anticoagulation clinic efficiency and implemented specifically targeted interventions. The resolution of workflow issues created a more streamlined patient visit. This provided more time for pharmacists to address important health issues specific to our indigent patient population. Other clinicians can apply this model to their practice setting to evaluate and make improvements to workflow efficiency as a means of providing highquality patient care.
authors.affiliation: University Thrombosis Center, College of Pharmacy, University of Utah, Salt Lake City, UT 84108, USA. vazquez@hsc.utah.edu
authors.forename: Sara R
authors.initials: SR
authors.lastname: Vazquez
authors.forename: Jennifer
authors.initials: J
authors.lastname: Campbell
authors.forename: Gale
authors.initials: G
authors.lastname: Hamann
authors.forename: Christa
authors.initials: C
authors.lastname: George
authors.forename: Laura
authors.initials: L
authors.lastname: Sprabery
mesh_terms: D000554:Ambulatory Care Facilities / Q000458:organization & administration*; D000925:Anticoagulants / Q000627:therapeutic use*; D017598:Efficiency, Organizational; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017146:Models, Organizational; D009819:Office Visits; D010595:Pharmacists / Q000458:organization & administration*; D010820:Physicians / Q000458:organization & administration; D011203:Poverty; D024382:Professional Role; D013647:Task Performance and Analysis; D013714:Tennessee; D013996:Time and Motion Studies; D014505:Urban Population; D000078329:Workforce
chemical_list: D000925:Anticoagulants