As ambulatory care continues to evolve as one of the fastest growing sectors in healthcare1, maximizing clinic efficiency becomes critical. One step leaders at Banner Health are taking to improve efficiency at their outpatient clinics is streamlining their adult intake form. Working with Cerner and multiple healthcare organizations as part of the Essential Clinical Dataset (ECD) group, ambulatory clinicians inventoried each field on the form and removed unnecessary fields. These optimizations have led to increased staff satisfaction and a decrease in clicks and charting time, and by decreasing the clinician's documentation burden, Banner Health is forecasting that this will translate to both improved access and more time with the patient.
“Using the ECD is alleviating some of the documentation burden and helping our clinicians document more efficiently,” said Sherri Hess, MS-IS, BSN, RN-BC, FHIMSS, chief nursing informatics officer. “The more efficient our clinics are, the easier it is for our consumers to get an appointment and the less time they have to sit in the waiting room.”
“Whenever we had to make a decision, we always thought about Sofia, the embodiment of a Banner patient,” said Loni Sailer, MBA, BSN, RN-BC, nursing informatics program director. “When we make improvements, or whenever we receive pushback on something we need to change, we always ask, ‘What would Sofia want? What would be best for Sofia’s experience?’ Our patients are always top of mind.”
The modified intake form reduced the number of sections from 17 to 10 and the number of fields from 319 to 112. Since implementation in early June 2021, Banner Health saw a 13% decrease in the average time it took to document the form2 and a 13.7% decrease in the average number of clicks within the form.3 This puts the organization on pace to save an estimated 9,000 hours annually4 and eliminate 10 million clicks every year.5
Banner's ECD project was supported by their culture of accountability and guiding principles of data capture with communication and training being key to their success. The team also sent out pre- and post-implementation surveys to help gauge improvement and user satisfaction.
“We paid close attention to what the medical assistants and nurses had to say about the changes, because they too are consumers,” said Holly Trenary, BSN, RN-BC nurse informatics coordinator. “We want them to spend less time with data entry and more time doing what they are trained to do, which is patient care.”
Going forward, Banner Health is continuing its ECD work by updating additional intake forms, including oncology, pediatric admission, outpatient pre-op and women’s health obstetrics, among several others.
1"The outpatient shift continues: Outpatient revenue now 95% of inpatient revenue, new report reveals," Advisory Board, 2019, accessed October 28, 2021, https://www.advisory.com/daily-briefing/2019/01/08/hospital-revenue
2Comparing baseline average time of 2:00 measured from February 1, 2021-May 1, 2021, to post-implementation average time of 1:44 measured from June 3, 2021-September 17, 2021, resulting in an average savings of 16 seconds.
3Comparing baseline average number of clicks of 29 measured from February 1, 2021–May 1, 2021, to post-implementation average number of clicks of 25 measured from June 3, 2021–September 17, 2021, resulting in an average savings of 4 clicks.
4Calculated by multiplying the 16 seconds post-implementation average time saved by the number of adult ambulatory intake forms completed between June 3, 2021, and July 16, 2021, resulting in a savings of 794 hours per month. Annualized estimation calculated by multiplying the monthly time saving by 12.
5Calculated by multiplying the 4 clicks saved in the post-implementation period by the number of adult ambulatory intake forms completed between June 3, 2021, and July 16, 2021, resulting in a savings of 857,102 clicks per month. Annualized estimation calculated by multiplying the monthly clicks by 12.