In the fall of 2014, Boulder Community Health (BCH) in Colorado consolidated the majority of its inpatient acute care operations into one location. As part of this process, BCH created a centralized registration area for all hospital services, which includes outpatient lab and imaging as well as all inpatient services. Given the anticipated increase in daily patient registrations, the hospital implemented a patient queuing system to streamline flow.
Over a three-year planning period, BCH used Lean Six Sigma process improvement principles to optimize flow, eliminate waste, create standard work, and ultimately select a technology to serve its patients better. We received input from many areas: the emergency department, lab, imaging, surgery, patients, families, physicians and visitors. The key stakeholders from the staff gave the design needs to the architect, and also helped select the technology to appropriately triage the high volume of patients. Using many Lean tools, we identified how many and what type of patients were to come daily. We also looked at the skills needed to serve them and how many registrars would be required. Finally, we evaluated the amount of time it would take to register, and calculated wait time thresholds to best serve their patients.
We designed 10 stations to register all patients for hospital services. Patients arrive at one, centralized lobby and are directed to check in at a kiosk, which prompts some general questions about the reason for the visit (for example, “Are you a scheduled patient?”). They then receive a ticket with a number that prioritizes that patient based on the type and time that the services are needed. Volunteers are also available to help patients and visitors if they need assistance with the kiosk. Patients, however, are becoming more and more comfortable with the technology as a standalone option.a
The staff can be flexed up or down depending on the varying volume. Wait times are less than five minutes and most patients are in and onto their service(s) inside of 10 minutes. These are industry-best standard performance goals. The workflow has also dramatically helped reduce errors, save labor costs, and minimize waits. It was a team effort and has achieved great outcomes.
BCH deployed two kiosks, powered by Vecna’s Patient Information Exchange registration solution. The kiosks have an 8” X 11” touchscreen that prompts patients to register. The podium of the kiosk prints a ticket with a number assigned to that patient. When the patient’s number gets called, a 42” monitor in the lobby lists their number along with a corresponding station, and an automated auditory message announces the patient number. The queue solution allows a patient to relax in the lobby, browse their phone and enjoy the view, instead of standing and waiting in a line.
We had an adjustment period of about 30 to 45 days. Patients have grown to like the system and have found it to be efficient, simple, and comfortable. They have expressed confidence in knowing where they are and in what order. We receive many compliments on the flow and the minimal wait times.
While many patients are responding positively, the solution is not for everyone. Technology can be intimidating to some, especially those that are accustomed to having a person greet them and get them registered up front. To account for this, patients can opt out anytime and ask for assistance from a registrar. Volunteers also routinely staff the area to help act as “ambassadors” to both the hospital and the process. BCH also performed focused interviews in the lobby after the solution was deployed. These interviews brought forth further enhancements surrounding signage, volunteer coverage, queuing options, and other changes to the implementation approach.
BCH is looking to the future in how we can enhance this workflow and technology. For one, we can expand the system to our ancillary sites. In addition, kiosks have the potential to interface with other platforms, such as scheduling, registration, payment, patient portals and biometric readers. Think “airlines.” We will closely evaluate those functions and where they might best fit our needs. A hospital will never have a system without people, but this can optimize that flow. This technology can enhance our efficiency and reduce our costs, all while improving the patient experience. It is hard to measure the direct impact to patients, but a patient that does not wait is typically happier than one that does.