During my sophomore year of college as a pre-med, I volunteered at the front desk of a free clinic, where it was typical to see patients waiting sometimes for more than two hours. At first I figured it was just because some patients took longer to examine than others. It wasn’t until I got certified as a nurse’s aide and started working in the medical department at the same clinic that I found out what was really going on.

It wasn’t that the doctors were taking longer to examine some patients; it was that the  medical staff didn’t always know that they had a patient waiting in the first place.

Our clinic has a pharmacy, dental, mental health and medical department, three of which are managed by the front desk staff. When a medical patient signs in, the receptionist puts the patient’s chart in a bin to let the medical staff know that a patient has arrived. There is no bell, no blinking light, so a nurse would only know when a patient  checks in by peeking down the hall every so often to see if a chart is in the bin. The bin was often blocked by hall traffic, closet doors and even carts filled with prescriptions, so the staff wouldn’t see the chart until long after the patient had arrived. And when the front desk couldn’t find the patient’s chart to begin with, the medical staff again wouldn’t know till much later – if at all – that a patient was in the waiting room.

So it was possible that our department wouldn’t realize  that someone was patiently waiting to be seen until we cleaned up at the end of the day, after all the doctors had left, and happened to find the lone patient still waiting in the lobby. I felt terrible whenever this happened. They had been waiting for hours, and all we could do was offer to reschedule their appointment.

Ideally, medical staff would peek down the hall at regular intervals, see the chart in the bin, room the patient and put a colored clip on the door of the room. Each doctor had a color, so he or she would know if the room held a patient that was waiting for them. But even after the patient was roomed, it was still possible for doctors to miss their patients.

Once, a physician asked me and another staff member if she had any other patients to see. Since the volunteer nurse who triaged her patients wasn’t present at the moment, we told her that if she didn’t see any rooms marked with a red clip, she was done for the day. However, there was a cabinet next to one of the examination rooms that made it impossible to see the clip from where we were standing. Naturally, we found another patient waiting in that examination room at the end of the day. Again, all the physicians had already left. These kinds of situations  occurred so often that I frequently found myself brainstorming ways to check in, room and see our patients more efficiently. I actively monitored the bin to make sure patients were triaged as soon as they came in. I even organized and labeled documents in separate folders to make it easier for the volunteers to triage patients, but this still didn’t fix the core problem.

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