Flowcharting Medical Processes

How to Draw Flowcharts

Purpose of Flowcharting

• Show the steps involved within the process.

• Determine where delays are, their causes, how to reduce them.

• Aid in communication of thoughts, ideas, and procedures.

Basic Flowcharting Shapes

Action or Process

Decision

Start/End

Flow

Delay

The terminator symbol marks the starting or ending point of a system.

The delay symbol marks a delay in the system showing that the next occurrence is not instantaneous.

The decision symbol marks a decision or branching point. Decisions are always binary (i.e. “yes” or “no”).

The process symbol can represent a single step or an entire sub-process.

Lines indicate the sequence of steps and the direction of flow.

Basic Flowchart

Start

Delay

Choice ProcessProcess Delay EndChoiceYes

No

Yes

Choice

No

Yes Process

ProcessNo

The above is an example of a basic flowchart. Like mostthings, flowcharts can be simpler or more complex.

Developing a FlowchartHere is an example of flowcharting in a clinic.

Check In

A flowchart always starts with a terminator, usually the terminator is a process; however, it can sometimes be associated with a decision that has only one result.

Check In

Handling Delays Within a Process

Check In Wait RoomWait Room

Decisions, Decisions, Decisions

Check InGathered

Info?YesWait Room

No

Decisions are important in determining what path to follow as a result of previous events. In the example above, as long as the info has not been gathered, the patient continues to wait in the waiting room.

GatheredInfo?

Yes

No

Actions and Processes

Check InGathered

Info?Gather InfoYesWait Room

No

Gather Info

And the Clock Keeps Ticking

Check InGathered

Info?Gather InfoYesWait Room Wait Room

No

Notice the additional delay of the waiting room, that the process “Gather Info” leads to another delay instead of the previous delay. This negates the need to “Gather Info” again, as it has already been gathered.

Wait Room

Got Nurse?

Check InGathered

Info?Gather InfoYesWait Room Wait Room

NurseAvailable?

No

Yes

No

As can be seen from this diagram, choices directly relate the path that the remainder of the system passes. In this example notice that if no nurse is available the patient remains in the waiting room.

NurseAvailable?

No

Yes

Obtaining Vitals

Check InGathered

Info?Gather InfoYesWait Room Wait Room

NurseAvailable?

No

Weight,Pulse, Meds,

& BP

Yes

No

Weight,Pulse, Meds,

& BP

What’s Next?

Check InGathered

Info?Gather InfoYesWait Room Wait Room

NurseAvailable?

No

Weight,Pulse, Meds,

& BP

Exam RoomAvailable?

No

Yes Yes

No

This shows a branching of the overall process. What happens if the exam room is not available? What does the patient do if the room is available?

Weight,Pulse, Meds,

& BP

Exam RoomAvailable?

No

Yes

We’re Off to See the Wizard, or are We?

Check InGathered

Info?Gather InfoYesWait Room Wait Room

NurseAvailable?

Wait Room

No

Weight,Pulse, Meds,

& BP

Exam RoomAvailable?

No

Take toExam Room

Yes Yes

No

Wait Room

Exam RoomAvailable?

No

Take toExam Room

Yes

¿¡More Waiting!?

Check InGathered

Info?Gather InfoYesWait Room Wait Room

NurseAvailable?

Wait Room

No

Weight,Pulse, Meds,

& BP

Exam RoomAvailable?

No

Take toExam Room

Yes

ExamRoom

Yes

No

Delays show that the system is not flawless, reducing the number and length of delays improves patient discharge time.

Wait Room Wait Room

Wait RoomExamRoom

2-10

2-10

2-205-20

Medicine Update

Check InGathered

Info?Gather InfoYesWait Room Wait Room

NurseAvailable?

Wait Room

No

Weight,Pulse, Meds,

& BP

Exam RoomAvailable?

No

Take toExam Room

Yes

ExamRoom

Yes

Update Meds

No

Update Meds

All I Ever Do is Wait.

Check InGathered

Info?Gather InfoYesWait Room Wait Room

NurseAvailable?

Wait Room

No

Weight,Pulse, Meds,

& BP

Exam RoomAvailable?

No

Take toExam Room

Yes

ExamRoom

Yes

Update MedsExamRoom

No

ExamRoom

Is There a Doctor in the House?

Check InGathered

Info?Gather InfoYesWait Room Wait Room

NurseAvailable?

Wait Room

No

Weight,Pulse, Meds,

& BP

Exam RoomAvailable?

No

Take toExam Room

Yes

ExamRoom

Yes

Update MedsExamRoom

No

MDAvailable?

No

Yes

ExamRoom

MDAvailable?

No

Yes

Finally…Results.

Check InGathered

Info?Gather InfoYesWait Room Wait Room

NurseAvailable?

Wait Room

No

Weight,Pulse, Meds,

& BP

Exam RoomAvailable?

No

Take toExam Room

Yes

ExamRoom

Yes

Update MedsExamRoom

MDInteraction

No

MDAvailable?

No

Yes

MDInteraction

Let’s Go Home

Check InGathered

Info?Gather InfoYesWait Room Wait Room

NurseAvailable?

Wait Room

No

Weight,Pulse, Meds,

& BP

Exam RoomAvailable?

No

Take toExam Room

Yes

ExamRoom

Yes

Update MedsExamRoom

MDInteraction

Check Out

No

MDAvailable?

No

Yes A flowchart usually ends with a terminator, designating the end of the process. However, occasionally, the flowchart will end with a decision if it is necessary to complete the process again after the process has been completed.

Check Out

Looking Back

Check InGathered

Info?Gather InfoYesWait Room Wait Room

NurseAvailable?

Wait Room

No

Weight,Pulse, Meds,

& BP

Exam RoomAvailable?

No

Take toExam Room

Yes

ExamRoom

Yes

Update MedsExamRoom

MDInteraction

Check Out

No

MDAvailable?

No

Yes

2-10

2-10

2-205-205-20

1

2

1

1

5

The delay times and the process times have been overlaid here to allow for interpretation of time spent in each stage of the process.

Total Wait: 17-80 min.

Total Interaction: 10 min.

Designing a Better Flowchart

• Determine the weaknesses of the system and how to improve efficiency.

• What is the best method to reduce delays?• Does every patient need to see the MD?• Does every patient need to see a RN?• Design choices to progress in parallel

branches, where returning to a previous step is minimized.