1. IMPROVED PHYSICIAN ACCESS HEART AND VASCULAR CENTER Team Members: John Roy Kathy Ragusa Sandra McCullough, RN Thomas McKiernan, MD Heart and Vascular Staff Division of Cardiology Staff

2. 3 rd available appointment access for NEW patients to the Heart and Vascular clinic was greater than 30 days. A review of physician scheduling issues identified complex scheduling processes that varied from physician to physician. Project Goal & Target: Standardize appointment scheduling 3 rd available for new patients of 14 days or less PATIENT ACCESS NEW PATIENTS GOAL

3. SOLUTIONS Standardized schedulesStandardized schedules –Reduced and standardized visit types from four to two New Patient Visit (NPV)New Patient Visit (NPV) Return Patient Visit (RPV)Return Patient Visit (RPV) –Modified pre scheduling messages to be clear and concise for all schedulers throughout the system. –Developed team scheduling concept with IDX and key word list to facilitate scheduling. –Identification of General Cardiology Team in every message for team scheduling capability in IDX.

4. SOLUTIONS Increased physician supplyIncreased physician supply –Added additional NPV slots to existing schedules –Utilized freeze/thaw slots to meet daily acute new patient visits –Added “New Patient Only” sessions –Ad hoc sessions, even for only 1 patient Created Expediter Role – Designated Service RepresentativeCreated Expediter Role – Designated Service Representative –Reviews daily new patient report to see if patients are scheduled appropriately and in less than 14 days. –Reviews daily schedules for accuracy and opportunities to schedule new patients from the wait list. –Serves as a liaison to referring physicians to facilitate scheduling new patients.

5. SOLUTIONS EducationEducation –Clinic service representatives were educated not to use “default” when scheduling return patients. –Educated Cardiology secretarial staff Wait list functionWait list function How to add/remove patients from the list.How to add/remove patients from the list. Not to use “default” when scheduling return patientsNot to use “default” when scheduling return patients –Physician communication Number of patients on their wait listNumber of patients on their wait list Collaboration to accommodate patientsCollaboration to accommodate patients Review 3 rd available data at monthly division meetingsReview 3 rd available data at monthly division meetings

6. NEW PATIENT REPORT DATE SCHEDULED SPECIALTYMRN APPOINTMENT DATE VISIT TYPE DAYS TO APPOINTMENT 5/1/2006 CARDIOLOGY ELECTROPH 5/16/2006NPV15 5/1/2006 5/18/2006NPV17 5/1/2006 5/22/2006NPV21 5/1/2006 5/9/2006NPV8 5/1/2006 6/28/2006NPV58 5/1/2006 5/24/2006NPV23 5/1/2006 5/18/2006NPV17 5/1/2006 CARDIOLOGY GENERAL 7/3/2006NPV63 5/1/2006 5/23/2006NPV22 5/1/2006 5/16/2006NPV15 5/1/2006 5/23/2006NPV22 5/1/2006 6/1/2006NPV31 5/1/2006 5/3/2006NPV2 5/1/2006 5/22/2006NPV21 5/1/2006 7/5/2006NPV65 5/1/2006 5/8/2006NPV7 5/1/2006 6/7/2006NPV37 5/1/2006 CARDIOLOGY HEART FAI 5/19/2006NPV18 5/1/2006 CARDIOLOGY INTERVENT 6/5/2006NPV35 5/1/2006 5/5/2006NPV4

7. RESULTS

8. 7%

9. 4%

10. Project Planning May-July 06 Project Implementation August 06 Target: 14 days

11. ANALYSIS It is important to understand the complexity and capabilities of appointment scheduling systemsIt is important to understand the complexity and capabilities of appointment scheduling systems –Rules –Standardization –Freeze/thaw –Team scheduling Communication between all areas of Cardiology, from the clinic to the department offices, is critical to effective appointment schedulingCommunication between all areas of Cardiology, from the clinic to the department offices, is critical to effective appointment scheduling

12. NEXT STEPS: Continue to use new patient report to identify scheduling issuesContinue to use new patient report to identify scheduling issues Look for opportunities to standardize expediter roll and train back up personnel.Look for opportunities to standardize expediter roll and train back up personnel. Develop a plan for expected and unexpected changes to maintain our 14 day goal.Develop a plan for expected and unexpected changes to maintain our 14 day goal. Share success with other Ambulatory specialty clinics.Share success with other Ambulatory specialty clinics.