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

2. Before the change….

3. 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.

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

5. Fishbone Analysis

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

7. 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

8. 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

10. 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

11. Televox
A patient call reminder system
“HOLES”

12. Derm Appointment Types
Tools
Derm Appointment Types
PSC Communication Tool

13. 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.

14. Missed Appt Process for RN
MA Process Long Term

15. 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

16. 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.

17. Current Results Sustained original results
Physician production increased to 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)

22. ROI
$1,088,293.57
3743%

23. 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

24. ADDENDUM