Decreasing Cycle Time at Busy Urban STD Clinics

Background: New York City (NYC) Bureau of Sexually Transmitted Disease Control (BSTDC) operates 9 STD clinics which provide free and confidential services 6 days/week on a walk-in basis.  Clinic visits have risen from 104,293 in 2005 to 124,195 in 2008.  Despite systematic introduction of efficiencies (medical record automation, formal patient triaging, streamlining the HIV pretest counseling process, and introduction of an express visit (EV) option for asymptomatic patients), 32% of patient complaints relate to clinic wait time. EV include registration, phlebotomy, HIV rapid test, submission of urine sample, and HIV test results. EV accounts for >50% clinic visits.

Objectives: To identify interventions to minimize patient wait time for express visits in STD clinics. To measure the impact of these interventions on patient cycle time.

Methods: Qualitative observations of overall clinic flow and EV wait-times were made in two STD clinics. EVs were timed by observation. Interventions to decrease wait-time between EV components were identified (registration prioritization given to EV patients, escort to phlebotomy rather than waiting room stop, doubling of staff assigned to providing HIV test results) and implemented in the two clinics. EV wait-times were re-measured. The interventions were then implemented in other STD clinics. EV cycle time and weekly median EV cycle time for all clinics prior to intervention were compared to weekly median EV cycle times measured at two-week intervals post intervention.

Results: EV cycle time decreased by 3 minutes in one of the initial test clinics and 7 minutes in the other.   At all STD clinics, baseline weekly median EV cycle was 93 minutes. Post intervention, median EV cycle time has fluctuated: 93, 87, and 89 minutes.

Conclusions: Interventions to date have had a minimal impact on overall EV cycle time.

Implications for Programs, Policy, and/or Research: Programs will learn concrete methods for measuring cycle time particularly in walk-in clinic settings.