title: Measuring the use of examination room time in oncology clinics: a novel approach to assessing clinic efficiency and patient flow.
abstract: OBJECTIVE
  The use of time in outpatient cancer clinics is a marker of quality and efficiency. Inefficiencies such as excessive patient wait times can have deleterious effects on clinic flow, functioning, and patient satisfaction. We propose a novel method of objectively measuring patient time in cancer clinic examination rooms and evaluating its impact on overall system efficiency.
  
  
  METHODS
  We video-recorded patient visits (N = 55) taken from a larger study to determine patient occupancy and flow in and out of examination rooms in a busy urban clinic in a National Cancer Institute-designated comprehensive cancer center. Coders observed video recordings and assessed patient occupancy time, patient wait time, and physician-patient interaction time. Patient occupancy time was compared with scheduled occupancy time to determine discrepancy in occupancy time. Descriptive and correlational analyses were conducted.
  
  
  RESULTS
  Mean patient occupancy time was 94.8 minutes (SD = 36.6), mean wait time was 34.9 minutes (SD = 28.8), and mean patient-physician interaction time was 29.0 minutes (SD = 13.5). Mean discrepancy in occupancy time was 40.3 minutes (range, 0.75 to 146.5 minutes). We found no correlation between scheduled occupancy time and patient occupancy time, patient-physician interaction time, and patient wait time, or between discrepancy in occupancy time and patient-physician interaction time.
  
  
  CONCLUSIONS
  The method is useful for assessing clinic efficiency and patient flow. There was no relationship between scheduled and actual time patients spend in exam rooms. Such data can be used in the design of interventions that reduce patient wait times, increase efficient use of resources, and improve scheduling patterns.
authors.affiliation: Wayne State University-Barbara Ann Karmanos Cancer Institute; and Josephine Ford Cancer Institute-Henry Ford Health System, Detroit, MI hamell@karmanos.org.
authors.forename: Lauren M
authors.initials: LM
authors.lastname: Hamel
authors.affiliation: Wayne State University-Barbara Ann Karmanos Cancer Institute; and Josephine Ford Cancer Institute-Henry Ford Health System, Detroit, MI.
authors.forename: Robert
authors.initials: R
authors.lastname: Chapman
authors.affiliation: Wayne State University-Barbara Ann Karmanos Cancer Institute; and Josephine Ford Cancer Institute-Henry Ford Health System, Detroit, MI.
authors.forename: Susan
authors.initials: S
authors.lastname: Eggly
authors.affiliation: Wayne State University-Barbara Ann Karmanos Cancer Institute; and Josephine Ford Cancer Institute-Henry Ford Health System, Detroit, MI.
authors.forename: Louis A
authors.initials: LA
authors.lastname: Penner
authors.affiliation: Wayne State University-Barbara Ann Karmanos Cancer Institute; and Josephine Ford Cancer Institute-Henry Ford Health System, Detroit, MI.
authors.forename: Rifky
authors.initials: R
authors.lastname: Tkatch
authors.affiliation: Wayne State University-Barbara Ann Karmanos Cancer Institute; and Josephine Ford Cancer Institute-Henry Ford Health System, Detroit, MI.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Vichich
authors.affiliation: Wayne State University-Barbara Ann Karmanos Cancer Institute; and Josephine Ford Cancer Institute-Henry Ford Health System, Detroit, MI.
authors.forename: Terrance L
authors.initials: TL
authors.lastname: Albrecht
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000592:standards / Q000706:statistics & numerical data; D000554:Ambulatory Care Facilities / Q000592:standards / Q000706:statistics & numerical data; D001071:Appointments and Schedules; D001509:Bed Occupancy / Q000706:statistics & numerical data; D001943:Breast Neoplasms / Q000628:therapy*; D002173:Cancer Care Facilities / Q000592:standards / Q000706:statistics & numerical data*; D017598:Efficiency, Organizational; D005260:Female; D006801:Humans; D008875:Middle Aged; D010362:Patients' Rooms / Q000592:standards / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D014850:Waiting Lists