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Originally printed in the SpaceMed Newsletter Spring-Summer 2014 www.spacemed.com

Physician Offices and Outpatient Clinics: How Many Exam Rooms? By Cynthia Hayward

BACKGROUND Physician practice space typically consists of a patient reception (intake) and wait-ing area, a number of identical exam rooms, several office/consultation rooms, one or more special procedure rooms, and associated clinical and administrative sup-port space. Physician practice space may be located in a medical office building (either freestanding or connected to a hospital), co-located with diagnostic and treatment services in a comprehensive ambulatory care center, or part of an insti-tute or center organized along a specific service line ― such as a Sports Medicine Center, Heart Center, or Cancer Center.

Planning space for physician offices and outpatient clinics begins with determining the number of exam rooms required. The need for other clinical space ― such as procedure rooms ― will depend on the specific medical or surgical specialties see-ing patients at the facility. However, the sizing of patient intake, administrative, and support space is generally based on the number of exam rooms.

PHYSICIAN-DRIVEN APPROACH When planning space for a private practice or when the anticipated schedule and staffing pattern have been firmly established, the number of exam rooms can be estimated simply by assuming a ratio of exam rooms per physician (or other care provider) during the peak weekday shift or clinic session. Two exam rooms per pro-vider are typically planned, although high-volume, quick turnaround specialties ― such as dermatology or surgery follow-up visits ― may effectively use three exam rooms per provider.

WORKLOAD-DRIVEN APPROACH Exam rooms were traditionally assigned to specific physicians regardless of the hours per week that he/she was present. In larger clinics, the number of exam rooms was typically driven by the demand on the peak half-day during the week. Because of the competing responsibilities of most physicians ― seeing inpatients, performing surgery and other procedures, seeing outpatients in other locations, attending conferences ― only a portion of the total physicians may use their allo-cated exam rooms at a given time. This results in significant variance in utilization of the exam rooms during the week. The variance between peak- and low-volume days is even more pronounced in academic medical centers where medical faculty also have teaching and research responsibilities that further reduce (and affect the scheduling of) their time in outpatient clinics.

With an emphasis on reducing capital and operational costs today, most organiza-tions strive to increase the utilization of exam rooms and minimize the overall foot-print of the space. This has led to increased scrutiny of exam room throughput and the development of more efficient operational models. By co-locating groups of ex-am and consultation rooms, they can be used by other provider teams during peri-ods of low utilization. Interest in “time-share” clinics is growing ― where physicians schedule exam/treatment rooms only when needed and share common patient and staff support services and space rather than “owning” their space.

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Physician Offices and Outpatient Clinics: How Many Exam Rooms? Continued

An analysis of the utilization of an existing physician practice or outpatient clinic begins with collecting data on the annual number of visits and weekly hours of op-eration. Dividing the annual physician visits by 50 weeks per year (allowing for holi-days) results in the average weekly visits. Based on weekly hours of operation, the portion of workload expected to occur evenings and weekends can be subtracted for space planning purposes. The average daily visits per exam room can be de-rived by dividing the average weekly visits occurring during the primary weekday shift by the number of exam rooms.

For example, 400 visits per week (Monday through Friday, 8:00 a.m. to 5:00 p.m.) with 24 exam rooms results in an average of 3.3 visits per exam room per day. If patients are typically scheduled two per hour in a particular clinic, a utilization factor of only 21 percent results. In this case, alteration of the planned scheduling pattern should be considered (i.e., so that fewer half-day clinic sessions per week are scheduled) resulting in the potential reassignment of the exam rooms to another provider team during other times of the week.

It should be noted that there may be other care providers in addition to the physi-cian ― such as physician assistants and nurse practitioners ― who see patients independently in an exam or consult room. Providers typically schedule a range of one to four patients per hour depending on the specialty and the proportion of new patient visits (which take longer) versus return or follow-up visits.

An exam room utilization factor as high as 90 percent can be assumed for private practitioners who do not have a high number of “no-show” patients. Teaching clin-ics, where care is provided primarily by residents supervised by academic physi-cians (who together spend longer times with patients) and where there is a large number of no-shows, typically see the fewest number of patients per provider. In this case, an exam room utilization factor of 70 percent may be used for planning purposes.

Well-planned physician practice space/outpatient clinics provide sufficient flexibility to accommodate sizable deviations from workload forecasts. This is accomplished by creating spaces that can be used interchangeably for various types of visits; by understanding the relationships among workload, visit times, and staffing to re-spond to unexpected surges in workload; and by accommodating a wide range of patient visits in a single flexible exam/treatment space.

Cynthia Hayward, AIA, is founder and principal of Hayward & Associates LLC. .