Best Practice Submission
“Yellow Card” Patient Transfer Identifier
Point of Contact: Maria “Mary Lou” DeLaLuz Jew, (210) 450-9738, JewM@uthscsa.edu
Claudia Thames, (210) 450-9339, ThamesC@uthscsa.edu
Group Involved with the Project: University of Texas Health Science Center at San Antonio,
Radiology and Orthopedic Clinics at the Medical Arts and Research Center
Submitted by Captain Denise Miranda
12 April 2012
Executive Summary: Many patients need to be imaged by radiology prior to their orthopedic
appointment at the Medical Arts and Research Center (MARC). Patients check in at the
orthopedic clinic front desk and are sent to radiology to be imaged. Many patients do not know
they must check in at the radiology front desk, therefore they take a seat in the radiology waiting
area. If patients are not seen right away, they will be late for their appointment back at
orthopedics, causing a backlog. The orthopedic clinic created a “yellow card” for patients to
carry to radiology, with instructions to check in at radiology, so the radiology clinic can quickly
identify those waiting to be imaged from the orthopedic clinic. The card identifier ensures
patients are checked in, triaged, treated and sent back in a timely manner as well as has
significant cost avoidance for physicians.
Objective of the Best Practice: Make orthopedic patients readily identifiable to the radiology
clinic front desk personnel so they can be imaged and sent back to orthopedics for their
appointment in a timely manner.
Background: The MARC orthopedic clinic sees a high volume of patients, which generates high
revenue, but relies on the radiology clinic for imaging their patients prior to their orthopedic
appointment. The radiology and orthopedic clinics were intentionally placed adjacent to one
another in the MARC to assist with flow and patient satisfaction due to their reliance on one
another. The radiology clinic acts an ancillary service for the entire MARC, but 85% of their
patients are from the orthopedic clinic. Adding to that, 85% of all orthopedic patients require an
image prior to their appointment, which can be as high as 25 per hour. Orthopedic patients are
notified to arrive 30 minutes early to accommodate this appointment. Due to language barriers,
age and other contributing factors, many patients do not know they must check in at the
radiology clinic front desk, even when told to do so by clinic personnel. Additionally, the
waiting rooms share a common area so it is difficult for the radiology front desk to differentiate
between patients who are there just for the orthopedic clinic, those who need an image for the
orthopedic clinic and those who are there just for radiology. In the past, many patients sat in the
waiting area for 20 minutes or longer before they approached the front desk to inquire as to how
much longer they would have to wait. In many instances, patients did not ask and it was not
until the orthopedic clinic personnel came to look for them that they realized they had not been
seen in radiology at all. This was causing a backlog in orthopedics due to appointments running
behind; as a result physicians did not have patients in rooms.
Implementation Methods: The orthopedic clinic created a bright yellow card for the patients to
carry with them to the radiology clinic, which differentiates them from radiology only patients.
They added instructions, with a recommendation to put a Spanish translation on the back side,
for the patient to check in at the radiology clinic front desk when they arrive. In the event that
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patient does not read the card and fails to check in, radiology front desk personnel are alerted to
the new orthopedic patient when they see the bright yellow card. There is a chance the card may
be lost or misplaced but it is minimal due to the short travel distance. If the card is lost or
misplaced, it will only have minor impact due to low probability. Once the patient has been
checked in, the radiology clinic collects the card. This process ensures that all orthopedic
patients are checked in, triaged and treated in a timely manner.
Results: Radiology front desk personnel stated that this has sped up the process significantly and
all patients are waiting 10-15 minutes less than previous wait times. It is not only beneficial for
the patient to be seen in a timely manner, but it is financially important as well. According to the
Texas Tribune, University of Texas Health Science Center as San Antonio Orthopedic Surgeon
faculty members make an average of $325,000 per year (Texas Tribune, Government Employees
Salaries, 2012) and each of the five physicians see an average of 40 patients per day. By
eliminating 10 minutes of wait time from half of the 85% of orthopedic patients, it could save as
much as $115,000 per year in wasted time for one physician.
This does not include the
additional patients that can be seen, (inpatient and outpatient) to generate additional revenue.
Table 1
Cost Avoidance per Year per Provider
Days / Yr
Pay / Min
85% of pt Load
Minutes Eliminated
Cost Avoidance
260
$2.60
34
10
$230,208.33
260
$2.60
17
10
$115,104.17
Conclusion: The focus in health care is to be patient centered and do as much as we can with the
resources we have been given. By simply giving the patients written instructions on a yellow
card as an easy identifier, it allows the patient to be seen in a timely manner for better patient
satisfaction, is significant cost avoidance and revenue generating potential.
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References
Government Employee Salaries Retrieved 4/5/2012, 2012, from
http://www.texastribune.org/library/data/government-employee-salaries/the-university-oftexas-health-science-center-at-s/departments/orthopaedics/11653/?page=1
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