title: Applying JIT principles to resident education to reduce patient delays: a pilot study in an academic medical center pain clinic.
abstract: OBJECTIVE
  This study investigated the effect on patient waiting times, patient/doctor contact times, flow times, and session completion times of having medical trainees and attending physicians review cases before the clinic session. The major hypothesis was that review of cases prior to clinic hours would reduce waiting times, flow times, and use of overtime, without reducing patient/doctor contact time.
  
  
  METHODS
  Prospective quality improvement.
  
  
  METHODS
  Specialty pain clinic within Johns Hopkins Outpatient Center, Baltimore, MD, United States.
  
  
  METHODS
  Two attending physicians participated in the intervention. Processing times for 504 patient visits are involved over a total of 4 months.
  
  
  METHODS
  Trainees were assigned to cases the day before the patient visit. Trainees reviewed each case and discussed it with attending physicians before each clinic session.
  
  
  METHODS
  Primary measures were activity times before and after the intervention. These were compared and also used as inputs to a discrete event simulation to eliminate differences in the arrival process as a confounding factor.
  
  
  RESULTS
  The average time that attending physicians spent teaching trainees while the patient waited was reduced, but patient/doctor contact time was not significantly affected. These changes reduced patient waiting times, flow times, and clinic session times.
  
  
  CONCLUSIONS
  Moving some educational activities ahead of clinic time improves patient flows through the clinic and decreases congestion without reducing the times that trainees or patients interact with physicians.
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Division of Pain Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
authors.forename: Kayode A
authors.initials: KA
authors.lastname: Williams
authors.forename: Chester G
authors.initials: CG
authors.lastname: Chambers
authors.forename: Maqbool
authors.initials: M
authors.lastname: Dada
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Christo
authors.forename: Douglas
authors.initials: D
authors.lastname: Hough
authors.forename: Ravi
authors.initials: R
authors.lastname: Aron
authors.forename: John A
authors.initials: JA
authors.lastname: Ulatowski
mesh_terms: D000046:Academic Medical Centers; D004503:Education, Medical, Graduate / Q000379:methods*; D006801:Humans; D007396:Internship and Residency; D018710:Pain Clinics / Q000458:organization & administration; D010820:Physicians; D010865:Pilot Projects; D017064:Process Assessment, Health Care; D013337:Students, Medical; D013997:Time Factors; D057188:Workflow
keywords: Ambulatory Care; Quality Improvement; Resident/Fellow Education