Improving Care for Urgent Dermatology Appointments

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Presentation transcript:

Improving Care for Urgent Dermatology Appointments Margaret Bell, MPH, R.N. Carol Drucker, MD

Before the change….

Example of a Problem Identified: Time to first open appointment: 142 days Patients with urgent problems were dealt with one by one, interrupting scheduler, nurse and doctor to look for a non-existent place in the schedule to put them. Urgent problems were on an appointment "wait list." for 79 days Temporary hold placed on “new” patients Clinics ran late routinely No lunch for the doctors, overtime for the nurses, and dissatisfaction and stress for all. Over 200 "missed appointment reschedules" were backlogged. Increased liability Lost revenue opportunities High patient dissatisfaction High provider and staff dissatisfaction.

ORIGINAL AIM: To decrease wait time for urgent appointments in Dermatology Cancer Prevention Center by 10% from July 2007 to December 2007

Fishbone Analysis

Potential Changes/Interventions Develop a process working in patients with urgent problems Develop a process of differentiating appointment types Revamp the missed appointment process

Develop a process for working in patients with urgent problems Restrict appointment in cancellation slots to a designated scheduling clerk. Develop a wait list with sufficient information to know who should be worked in Develop a system of prioritizing of the patients with urgent problems on the urgent list Develop tools for PSC/RN’s

New Prioritization Process Patients prioritized to high/low risk by RN/MD Form developed to communicate risk to scheduling clerk Appointments types changed to accommodate risk

Current Missed Appointments Process Current process : Annual low risk screenings given same weight as high risk Three phone calls to patient missing appointment by RN Scheduling clerk reschedules appointment up to 3 times Business Center verifies insurance each visit All patients given 15 minute appointment

Televox A patient call reminder system “HOLES”

Derm Appointment Types Tools Derm Appointment Types PSC Communication Tool

New Process Instead of 3 calls and 3 reschedules: Low Risk: Only letter without reschedule High Risk: Letter reminder at risk with factors identified Undiagnosed: Individually follow up by MD or RN.

Missed Appt Process for RN MA Process Long Term

A new world ……… Improved work flows Difficult problems tackled Work together better Improve working conditions Improve access for your patients Employees smile when they come to work

Final Results Improved by 91.14% AIM: To decrease wait time for urgent appointments in Dermatology Cancer Prevention Center by 10% from July 2007 to December 2007. INITIAL RESULTS: Improved by 91.14% Access less than 48 hours for urgent patients Urgent wait list gone Initial savings Televox $18,100 for 1st year.

Current Results Sustained original results Physician production increased to 11.13 patients resulting in a net increase of 589 patients per year Televox was expanded to all out patient centers CPC general screening and mammogram appointments generated Downstream revenue: 1531 additional pathology specimens ~26 patients were treated (GELB)

ROI $1,088,293.57 3743%

Sustaining the Gain James - Rebviltlraq Projects Found Crumbling “What ultimately makes any project sustainable is local ownership from the beginning in designing the project, establishing the priorities.” James - Rebviltlraq Projects Found Crumbling NY Times. Sun 29 Apr07

ADDENDUM