Office optimization

The exam room often makes up for less than half of the medical office space, but the exam room is the primary place where physicians and patients develop their relationship. The design and set up of this space should be carefully considered to optimize efficiency, workflow, and patient engagement.

Design efficiencies

Let’s begin with design efficiencies.

Number of rooms

Determining the number of rooms you need is an important first step in the planning process. Here are two key guiding metrics you should consider:

• Number and types of visits you typically have

• Number and types of procedures you perform most often

To optimize productivity and patient flow make sure you have enough rooms to accommodate your practice’s needs, but not so many rooms that some rarely see use.

Size

The typical size for a dermatology exam room to function optimally is approximately 9 to 10.5 feet wide by 12 to 14 feet long, with some variation. Each room should have enough space to comfortably accommodate the dermatologist, one clinical staff (nurse or medical assistant), and the patient and one guest (a parent or other family member). The room should also be compliant with Americans with Disabilities Act (ADA) guidelines on access for those with disabilities.

Layout

Each room should have an identical layout to maximize efficiency. Ensure there is enough room for comfortable movement and there is flexibility to accommodate changes for a unique visit. It is particularly important that you be able to move completely around the exam chair to conduct procedures.

Furnishings

When it comes to furnishings each room should be equipped with:

For physicians and clinical staff

• Exam chairs, which should be selected based on the type of procedures you perform, comfortability, adjustability, and budget. Consider power exam/procedure chairs if possible, to help with positioning patients.

• Mobile surgical carts and electrosurgical units that can be rolled from one room to the next.

• Medical-grade cabinetry with ample room and storage to minimize visual clutter and the need to leave the room.

• Comfortable, modular, and flexible seating for the dermatologist, the patient, and at least one companion to accommodate all needs.

• Either fixed or movable computer station with laptops or tablets.

  • Movable stations and cordless devices allow for easy transition from room to room and save space

• Hygiene area with a countertop, sink, soap dispenser, touchless hand sanitizer, and paper towel dispenser.

• Basic diagnostic equipment mounted on the wall for easy access, including hyfrecators.

• Abundant power outlets (upper and lower) throughout the room.

For patients

A touchless hand sanitizer for patients by the room entrance

• Hooks or door hangers for patient personal items

• Easily accessible power outlets, tissues, etc.

Finally, to add a bit of personality and warmth, consider tranquil walls colors, soft music, and complementary artwork.

Finishes

For both the movable and fixed furnishings, select finishes that are durable that can be quickly and easily sanitized between patients. This includes flooring — avoid carpeting, because uncarpeted floors allow easier moving of equipment as well as more effective disinfection.

Lighting

It is important to consider lighting as well, not just for aesthetics but for the types of procedures you will perform.

Particularly in surgical rooms, consider fluorescent units along with a ceiling-mounted surgical light with one or two heads for ease of use. Also, consider a halogen light directly above the patient’s exam table to ensure ample light during examination. In general, be sure to position the lights where you need them for different procedures. Cost and energy efficiency should also be taken into account.

Soundproofing

Maintaining privacy throughout the patient visit is important. For exam rooms, consider insulating the walls and putting high-quality textured acoustical tile on the ceilings. Install commercial-quality solid wood doors. Cover the walls with vinyl, which is quieter and lasts longer than paint.

Communication

Nurse call systems can be an integral part of patient care by allowing for ease of communication between the dermatologist and nurse(s). A typical nurse call system consists of a central console, a remote switching device, hallway lights, power supply, and interconnecting wiring. While there is a considerable cost associated with this sophisticated system, it can significantly improve efficiency by announcing patient arrival, indicating sequence of patients, signaling that the patient is ready to be seen, or communicating the need for a nurse.

Medical supplies

Standardizing supplies in the exam room is key. Stock each room with the same supplies in the same location. Looking for supplies should not be a guessing game and should not require you to exit the room during a patient visit.

Note: You can purchase medical supplies and furniture at a discount through the Academy’s member buying program.

Workflow efficiencies

Now, with the exam room set-up, let’s talk workflow efficiencies.

The most significant change a practice can make to improve efficiency in workflow is the adoption of customizable technologies. These include:

Electronic health records (EHR) – Adopting the right EHR and learning how to optimize your system is a huge time and headache saver. When shopping for an EHR system look for:

• Cost

• Ease of use

• Integration

• Implementation and training

• Customer service

The AAD has several tips on integration and maintenance as well as helpful templates.

Prescribing and prior authorizations– Processing prior authorizations wastes practice resources. A 2020 survey from the Academy found that prior authorizations take up 3.5 hours of work each day for assigned staff and that office administrators believe they could schedule five additional patients per day with the time spent on prior authorizations.

Scribes – Dermatologists adopting a number of time- and labor-saving strategies for documenting the patient visit. These include in-room scribes that follow the physician into the exam room to document the patient encounter, e-scribes that listen to a real-time encounter from a remote location and enter notes into the EHR, or voice recognition software that transcribes dictation and integrates with your EHR.

Mobile apps – Mobile apps can play a big role in saving time and making your practice more efficient. Popular apps help with dermatology education, HIPAA compliance, scribes, team conferencing, decision support, and interpretation/translation services. Apps that integrate with your EHR can be especially valuable.

Platforms for teledermatology – Having a physical building to see patients in does not mean you cannot incorporate telemedicine to grow or improve patient care. Telehealth is especially important for dermatology, because of insufficient coverage of rural areas. Smart use of teledermatology can increase revenue and efficiency.

In addition to the adoption of technologies, make workflow efficiencies to reduce burdens, save time, and minimize waste.

• Have the patient complete their history in advance of the visit via the patient portal, or have your medical assistant take a comprehensive history using this ancillary checklists (PDF) developed by the Academy.

• Use clinical protocols to streamline the diagnosis process and ensure comprehensiveness and consistency in documentation.

• Complete documentation during the visit (see e-scribes, above) or immediately after to reduce “pajama time,” time spent on documentation after office hours.

• Use e-prescribing to send scripts directly to the patient’s preferred pharmacy, to reduce errors and time spent after the visit is complete.

• Avoid “idle” anesthetic wait time to expedite patient flow.

  • If a biopsy, destruction, removal, etc. is needed, inject the lesion(s) early in the visit to allow numbing time during the remainder of the exam and then complete the procedure.

  • Inject anesthetic for one patient and move to the next patient in another exam room to allow time for the anesthetic to work.

• Provide the patient with a written after-care summary to take home. The summary should include:

  • Medication – Review of the patient's medication, including the name, dosage, frequency, and route of each medication.

  • Medication allergy – Review of the patient's known medication allergies.

  • Current problem list – Review of the patient’s current and active diagnoses.

From design to diagnosis to documentation, there are numerous opportunities for increased efficiency. Spend time walking through your practice to identify and implement improvements.

Use our online form to contact practice management staff for questions or concerns.