Door-to-provider time is the time from a patient's arrival to their first contact with the physician, NP or PA. When it rises, the cause can be the front desk, the rooms, the support staff or the provider hours. Each cause has a different fix, so the first job is to measure door-to-provider time in a way that shows which one you have.
Define Door-to-Provider Time the Same Way Every Day
Two clinics can report the same number and mean different things by it. Write down your definition and don't change it.
The start. Pick one: the moment the patient walks in, the moment check-in starts, or the moment registration is complete. For patients who check in online or hold a place in line from home, decide whether the clock starts at the online check-in or at arrival. Report those patients separately if your EMR allows it.
The end. Pick one: the provider opens the chart, or the provider enters the room. These can be several minutes apart.
How the timestamps get recorded. Most EMRs record a time when a staff member changes the patient's status. On a busy shift those clicks happen late, so the busiest hours can look better or worse than they were. Watch a few visits with a clock and compare them with what the EMR recorded.
Split Door-to-Provider Time Into Three Segments
One number can't tell you where the patient waited. Three segments can.
- Arrival to registration complete. The patient is at the front desk.
- Registration complete to roomed. The patient is in the waiting room.
- Roomed to provider. The patient is in an exam room, waiting for the physician, NP or PA.
Report each segment by hour and by shift, with the staffed hours for each role beside it. A daily average hides the hours where the wait happens.
What Each Door-to-Provider Segment Points To
| Segment that grew | Likely cause | What to check |
|---|---|---|
| Arrival to registration complete | Too few front desk hours, or a slow registration step | Front desk staffing by hour. How long insurance checks and forms take. |
| Registration complete to roomed, with rooms empty | Too few MA or RN hours to room patients | MA and RN staffing by hour. |
| Registration complete to roomed, with rooms full | Rooms held by patients waiting on results, discharge or the provider | How long patients stay in a room after the provider has seen them. |
| Roomed to provider | Too few provider hours for the arrivals, or a provider who's new to the clinic | Arrivals per provider hour. Who was working. |
The second and third rows look the same in the total. The fix for one is support staff, and the fix for the other is room turnover or provider hours.
Separate the Shifts Worked by a Clinician Who's New to Your Clinic
A clinician on a first or second shift at your clinic is learning your EMR setup, your room layout and your staff while the shift runs. Their roomed-to-provider time is longer for reasons that have nothing to do with how many provider hours you scheduled.
Mark those shifts in your report and look at them apart from the others. If the long waits are mostly on first shifts, the fix is orientation and more returning clinicians. Adding hours won't change it. What locum turnover costs a clinic covers how to measure that, and the EMR access checklist for locum clinicians covers the setup that shortens it.
Compare Door-to-Provider Time With Your Own History
Set your target from your own data. Take the weeks when the clinic was fully staffed and ran well, and use the door-to-provider time from those weeks as the baseline for each hour of the day.
Then compare like with like: this Monday afternoon against past Monday afternoons, and not against the weekly average. A number that's normal for your busiest hour would be a warning sign in your slowest.
Look at the number of patients who left before being seen alongside it. Those patients have no door-to-provider time, so a shift where several patients gave up can report a better average than a shift where everyone stayed.
When Door-to-Provider Time Is a Staffing Problem
If the roomed-to-provider segment grows in the same hours every week, and arrivals per provider hour are high in those hours, the block needs more provider hours. A faster check-in won't change it.
Fixing urgent care wait times with shift coverage covers how to work back from a wait time target to the provider hours each block needs.
If a different segment grew, start there. A front desk or rooming problem treated with an extra provider costs a shift's pay and leaves the wait where it was.
Rediworks is a self-service marketplace for urgent care locum shifts. You post the shifts you need by clinician type, date and hours. Sign up to post shifts.