title: Measuring process change in primary care using real-time location systems: feasibility and the results of a natural experiment.
abstract: BACKGROUND
  Objectively measuring the effect of primary care process interventions is very challenging. Real time location systems (RTLS) hold the potential to solve this problem.
  
  
  METHODS
  An outpatient clinic was outfitted with a RTLS based on active-RFID (radiofrequency identification). Staff and patients volunteered to wear RFID transponders which unobtrusively recorded time and location. Wearers were identified only by their role: Patient, MA, RN, MD. The clinical process intervention consisted of reorganizing how medical assistants were utilized from a ad hoc common pool of medical assistants to dedicated assignment of medical assistants. Process measures were recorded before, during and after the intervention.
  
  
  RESULTS
  230 unique patient encounters were recorded from October 2009-January 2010. Eight MDs, 7 MA and 6 RNs participated. Total flow time was significantly decreased while waiting room time was increased. Variance was significantly reduced for both total flow time and face time. In-room wait time and patient face time were decreased, though this did not reach statistical significance.
  
  
  CONCLUSIONS
  Objectively measuring process change in primary care is feasible using RTLS. In this case the intervention resulted in the waiting room being used more effectively as a process buffer smoothing flow and potentially increasing clinic capacity.
authors: Massachusetts General Hospital - Institute for Technology Assessment, Boston, MA 02114, USA. jstahl@partners.org
authors: James E
authors: JE
authors: Stahl
authors: Mark A
authors: MA
authors: Drew
authors: Donna
authors: D
authors: Leone
authors: Rosemary S
authors: RS
authors: Crowley
mesh_terms: D000554:Ambulatory Care Facilities / Q000458:organization & administration* / Q000706:statistics & numerical data; D006801:Humans; D009726:Nurses; D019370:Observation; D010823:Physician Assistants; D010820:Physicians; D011320:Primary Health Care / Q000458:organization & administration* / Q000706:statistics & numerical data; D017064:Process Assessment, Health Care / Q000379:methods / Q000458:organization & administration*; D013647:Task Performance and Analysis