FACE-TIME VERSUS TEST ORDERING: IS THERE A TRADE-OFF?

Purpose: Patient/Clinician face-time encompasses much of the activity related to clinical decision making. Recent studies indicate that as face-time shrinks so does the number of clinical issues addressed. One strategy clinicians may pursue is “off-loading”, e.g., trading diagnostic reasoning for testing or referrals. Therefore, we hypothesize that the shorter clinical face-time the more likely patients will receive testing.

Method: Several primary care (PC) and urgent care (UC) clinics were wired with RFID-based Real-time location systems. Clinicians and patients were asked to wear RTLS tags. Face-time is defined as the duration patients and clinicians are co-located in the same room. Radiology testing was used as a proxy for encounter-driven testing. A radiology test was determined to be associated with a clinical encounter if it shared the patient's unique identifier and was the first radiology test to occur < 3 months after the index encounter. Testing data was derived from the hospital research patient data registry. Data was analyzed using JMP™(SAS, Cary, NC) using standard statistical analytic methods. This project was IRB approved.

Result: From 7/2008 to 10/2010, 2086 unique clinical encounter medical records and measured face-times were associatable. Gender: 35%/65% M/F, age: median 45 y.o. range 19-96, Race: 77% Caucasian, 7.8% Black, 7.3% Hispanic, 5.5%, Asian. PC(n) = 1957, UC(n) = 129. 792 patients had radiology tests, 407 met study criteria. 9% of visits resulted in testing PC whereas 55% of UC tests resulted in some form of radiology testing. Testing resulted in shorter face and wait time in PC and shorter wait and same Face in UC (see figure).

Conclusion: Our study suggests trade-offs between face-time and testing occur. Shorter face-time in PC was associated with more testing, this was not true in UC. This may relate to different demands. PC is oriented more towards maintenance than discovery; with incentives to increase access - less time per patient may translate into more patients/day. UC tends to place more emphasis on same day discovery and less on volume. The larger question is whether or not these trade-offs are or are not desirable for the patient, clinician and healthcare system. Future work will include correlating this information with appropriateness data from the local EHR radiology order entry system.