Applying JIT principles to resident education to reduce patient delays: a pilot study in an academic medical center pain clinic

Pain Med. 2015 Feb;16(2):312-8. doi: 10.1111/pme.12543. Epub 2014 Sep 16.


Objectives: This study investigated the effect on patient waiting times, patient/doctor contact times, flow times, and session completion times of having medical trainees and attending physicians review cases before the clinic session. The major hypothesis was that review of cases prior to clinic hours would reduce waiting times, flow times, and use of overtime, without reducing patient/doctor contact time.

Design: Prospective quality improvement.

Setting: Specialty pain clinic within Johns Hopkins Outpatient Center, Baltimore, MD, United States.

Participants: Two attending physicians participated in the intervention. Processing times for 504 patient visits are involved over a total of 4 months.

Intervention: Trainees were assigned to cases the day before the patient visit. Trainees reviewed each case and discussed it with attending physicians before each clinic session.

Primary and secondary outcome measures: Primary measures were activity times before and after the intervention. These were compared and also used as inputs to a discrete event simulation to eliminate differences in the arrival process as a confounding factor.

Results: The average time that attending physicians spent teaching trainees while the patient waited was reduced, but patient/doctor contact time was not significantly affected. These changes reduced patient waiting times, flow times, and clinic session times.

Conclusions: Moving some educational activities ahead of clinic time improves patient flows through the clinic and decreases congestion without reducing the times that trainees or patients interact with physicians.

Keywords: Ambulatory Care; Quality Improvement; Resident/Fellow Education.

Publication types

  • Clinical Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Academic Medical Centers
  • Education, Medical, Graduate / methods*
  • Humans
  • Internship and Residency*
  • Pain Clinics* / organization & administration
  • Physicians
  • Pilot Projects
  • Process Assessment, Health Care*
  • Students, Medical
  • Time Factors
  • Workflow*