A Doctor’s Innovative Solution for Spiking Wait Times in Outpatient Clinics

Anjna Ganatra, MD, chief of ambulatory care at NYC Health + Hospitals/Metropolitan.
Anjna Ganatra, MD, chief of ambulatory care at NYC Health + Hospitals/Metropolitan.

As a career-long family doctor, Anjna Ganatra, MD, knows how valuable each minute can be in an exam room.  

More efficient appointments don’t only equal happier patients, but also a more seamless day for physicians, a strong reputation for the hospital, and, in the long run, access to quality health care for more people in the community. 

“If I save 20 minutes on every patient, then I can see more patients during the day,” said Dr. Ganatra, the chief of ambulatory care at NYC Health + Hospitals/Metropolitan. “I want our patients to go out in the world and say, ‘At Metropolitan it doesn’t take you an hour and a half to see your doctor. You can usually get out within an hour, and, by the way, you get your blood drawn, you get your shots done and the nurses come in and teach you all these things.’” 

Thanks to Dr. Ganatra, both Metropolitan’s adult care and family care patients are on their way to saving around 17 of those precious minutes each visit. This represents a dramatic 20 percent drop in exam times, which had spiked significantly during the pandemic.  

The marked improvement followed the creation of new clinic workstations, an innovation spurred by Dr. Ganatra’s project with United Hospital Fund and the Greater New York Hospital Association’s Clinical Quality Fellowship Program.  

In the project, Dr. Ganatra decided to tackle lagging appointment times among senior adult medicine residents. The appointment times had surged to an average of 80 minutes, in part because nurses and medical assistants couldn’t start blood work, urine tests, or other orders until physicians finished inputting records and notes onto the exam room computer. COVID protocols that required vital signs, screenings, examinations, procedures, EKGs, venipuncture, and immunizations to be done in the exam room instead of extra communal space only exacerbated the problem. 

Since the number of rooms and computers was very limited and costly construction of more space was off the table, Dr. Ganatra came up with an inventive idea to give residents somewhere to input their records. She brought in mobile “workstations on wheels” that residents could use to input notes while nurses and medical assistants started tests and other orders. 

The simple but effective solution proved that extra workstations could shave a “remarkable” 16.74 minutes off the adult care facility’s average wait time. The findings have since spurred the establishment of a standalone workstation at the adult care facility and the expansion of the mobile stations to the family care unit. 

“That’s really important,” Dr. Ganatra said. “Our patients’ time is valuable.” 

Those valuable time savings would not have been possible without UHF’s 15-month fellowship, according to Dr. Ganatra. The doctor noted that the program taught her “everything” she previously hadn't known about running a performance improvement project, so much so that she recently embraced a role as Interim Chief Quality Officer at Metropolitan. 

"When the opportunity came for me to help out our organization, I was able to step up from all the knowledge I gained from the CQFP,” she said. “All of my formal information and education [on quality improvement] I learned from the Clinical Quality Fellowship Program.” 

Started in 2009, the Clinical Quality Fellowship Program has trained 260 mid-career physicians, nurses, and physician assistants from over 50 health care facilities in the New York metropolitan area to become quality improvement and patient safety leaders in their organizations. The 15-month program graduates a new class of these change-makers on the front lines of health care each year.