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Development of a primary care physician task list to evaluate clinic visit workflow
  1. Tosha B Wetterneck1,2,3,
  2. Jamie A Lapin2,4,
  3. Daniel J Krueger2,4,
  4. G Talley Holman5,
  5. John W Beasley6,
  6. Ben-Tzion Karsh2,3,4,6
  1. 1Department of Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin, USA
  2. 2Center for Quality and Productivity Improvement, University of Wisconsin, Madison, Wisconsin, USA
  3. 3Systems Engineering Initiative in Patient Safety, University of Wisconsin, Madison, Wisconsin, USA
  4. 4Department of Industrial and Systems Engineering, University of Wisconsin, Madison, Wisconsin, USA
  5. 5Department of Industrial Engineering, University of Louisville, Louisville, Kentucky, USA
  6. 6Department of Family Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin, USA
  1. Correspondence to Dr Tosha B Wetterneck, Division of General Internal Medicine, UW School of Medicine and Public Health, 310 North Midvale Blvd., Madison, WI 53705, USA; tbw{at}medicine.wisc.edu

Abstract

Background Interventions designed to improve the delivery of primary care, including Patient-Centered Medical Homes and electronic health records, require an understanding of clinical workflow to be successfully implemented. However, there is a lack of tools to describe and study primary care physician workflow. We developed a comprehensive list of primary care physician tasks that occur during a face-to-face patient visit.

Methods A validated list of tasks performed by primary care physicians during patient clinic visits was developed from a secondary data analysis of observation data from two studies evaluating primary care workflow. Thirty primary care physicians participated from a convenience sample of 17 internal medicine and family medicine clinics in Wisconsin and Iowa across rural and urban settings and community and academic settings.

Results The final task list has 12 major tasks, 189 subtasks, and 191 total tasks. The major tasks are: Enter Room, Gather Information from Patient, Review Patient Information, Document Patient Information, Perform, Recommend / Discuss Treatment Options, Look Up, Order, Communicate, Print / Give Patient (advice, instructions), Appointment Wrap-up, and Leave Room. Additional subcodes note use of paper or EHR and the presence of a caregiver or medical student.

Conclusions The task list presented here is a tool that will help clinics study their workflows so they can plan for changes that will take place because of EHR implementation and/or transformation to a patient centered medical home.

  • Primary care
  • workflow
  • task analysis
  • EHR
  • adverse events
  • epidemiology and detection
  • human factors
  • medication safety
  • failure modes and effects analysis (FMEA)
  • hospital medicine
  • compliance
  • human error

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Footnotes

  • Funding This study was supported in part by grants K08 HS17014 from the Agency for Healthcare Research and Quality (PI: Wetterneck), P20 HS017115 from the Agency for Healthcare Research and Quality (PI: Karsh), R18 HS017899 from the Agency for Healthcare Research and Quality (PI: Karsh), the Department of Medicine at the UW School of Medicine and Public Health, and 1UL1RR025011 from the Clinical & Translational Science Award (CTSA) program of the National Center for Research Resources National Institutes of Health. These agencies had no other role in the design, conduct, and reporting of this research.

  • Competing interests None.

  • Ethics approval Ethics approval was provided by University of Wisconsin Health Sciences IRB.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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