Monona Clinic Pilots No-Wait Patient Rooming

It's hard to imagine a clinic visit that doesn't include time spent in the waiting room, watching other patients come and go until the nurse calls your name.

But for patients at UW Health Monona, that experience is becoming a thing of the past.

That's because family physicians there are adopting a new rooming process in which patients proceed directly to the exam room, bypassing the waiting room altogether.

"No-wait" rooming, which Byron Marquez, DO first launched in January with his practice, has been overwhelmingly well received by patients, and may pave the way for similar processes at other clinics in the future.

Modeled After Hotel Wayfinding

The no-wait rooming process is similar to hotel check-in and check-out procedures. It works as follows:

1. Patients check in at the reception desk, where they are given a card with an exam room number and a map to the room.
2. Patients proceed directly to the exam room, place the card in the rack on the outside of the door, and close the door.
3. The medical assistant then goes directly to the exam room to greet the patient.
4. The exam itself proceeds normally.
5. Afterwards, the patient returns the room card to the reception desk, which indicates that the exam room is available again.

Adapting an Existing Infrastructure

Although Dr. Marquez spearheaded no-wait rooming at the Monona Clinic, he first heard that this was being done in a pediatric clinic at Seattle's Virginia Mason Medical Center.

He decided to pilot the idea here as part of a system-wide primary care process improvement project. Working with his clinical team and clinic manager John Otterson, a process was designed that would work with the clinic's existing layout.

The team made some small adjustments, like placing room numbers perpendicular to the wall so patients can see them as they walk down the hall. But for the most part, the new process uses the same systems and infrastructure as before.

For example, the clinic's computer system still notifies staff when a patient has arrived. And because most exam rooms are clearly visible from the nursing station, clinic staff can see when a patient walks by or when a check-in card is placed in the door rack.

"When the idea was first discussed it seemed so simple," said clinic nurse Matthew Rajala, RN. "Implementing the plan was even easier. All it really took was being observant for the 'signs' that a patient had checked in."

"Our clinics weren't designed for this, but it's working anyway," agreed Dr. Marquez. "In fact, the new process is much more efficient for clinic staff, since they don't have to walk each patient to and from the waiting room. It saves them a lot of steps."

Positive Results, Broader Implementation

Patients' response to the new process has been tremendously positive. For the first week of the pilot, each patient received a one-question survey, asking whether they preferred no-wait rooming to the traditional rooming process.

All but a handful have indicated a preference for no-wait rooming, commenting that it takes less time, protects their privacy better, and prevents exposure to illness in the waiting room. "More than one patient has said that they wish other clinics did it this way," said Otterson.

Clinic staff also measured the time between patient check-in and when a medical assistant greets the patient in the exam room. They found that this time dropped by 25% to 40% in Dr. Marquez' practice during the first week, despite the fact that wait times were low to start with. They also found that continued measurement was a motivation to work efficiently as a team.

"One great byproduct of the new rooming process is that each member of the clinical staff works more efficiently," said Rajala. "From check-in to check-out, this process has improved communication and teamwork throughout the clinic."

These results go a long way towards meeting organizational goals, Dr. Marquez said. "Patient satisfaction and wait times are two key factors we know we need to improve," he said. "This process addresses those issues in a simple way."

According to Dr. Marquez, as other clinicians saw no-wait rooming working for patients and staff, they began asking, "When can I do this, too?" So far, four of the nine family physicians at the clinic have tried no-wait rooming, and the rest may follow in time.

The clinic is also in the process of designing a new, combined practice with UW Health McFarland, scheduled to open in late 2010, and Dr. Marquez would like to see no-wait rooming implemented at the new location.

"As we design a new clinic, we can make no-wait rooming even easier for patients and staff," said Dr. Marquez. "We can improve wayfinding for patients, our signaling system for staff, and our overall clinic design to make all parts of our patients' experience convenient, efficient, and timely."

"And, if no-wait rooming makes a waiting room obsolete," he added, "we can use that space for more useful things than waiting."