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Anticoagulation clinic workflow analysis.

OBJECTIVE
To evaluate a workflow model and define factors affecting patient visit length in an anticoagulation clinic primarily treating an urban patient population.


DESIGN
Workflow analysis.


SETTING
Anticoagulation clinic in Memphis, TN, between November 2005 and April 2006.


PATIENTS
240 and 246 patient visits were assessed pre- and postintervention, respectively.


INTERVENTION
For 7 weeks, pharmacists documented factors affecting visit length and problems addressed during the visit, which were classified as anticoagulation or non-anticoagulation related. Following data analysis, changes were made to address inefficiencies in the clinic workflow. Postintervention data were collected for 7 weeks to assess the impact of these interventions.


MAIN OUTCOME MEASURES
Patient visit length and factors affecting patient visit length.


RESULTS
Factors affecting visit length were overbooking, pharmacist preceptor availability, attending physician availability, and repeat venipuncture. To target these inefficiencies, changes were made to the clinic schedule and workflow and a patient-provider agreement was implemented. These interventions decreased the frequency of the visit length factors significantly. As a result, pharmacist providers addressed significantly more total problems (anticoagulation problems plus nonanticoagulation problems) without an increase in visit length.


CONCLUSION
Periodically evaluating workflow efficiency and making changes, if indicated, is important. In this study, we identified areas for improvement in anticoagulation clinic efficiency and implemented specifically targeted interventions. The resolution of workflow issues created a more streamlined patient visit. This provided more time for pharmacists to address important health issues specific to our indigent patient population. Other clinicians can apply this model to their practice setting to evaluate and make improvements to workflow efficiency as a means of providing highquality patient care.