Background/Purpose: Patient satisfaction is an important driver of patient-centered care. The Section of Rheumatology was taking on average 5 days to contact and schedule new patients for consultation, with only 30-50% of patients rating the scheduling experience as excellent. Our practice was tasked by an organizational goal of Dartmouth-Hitchcock to reduce new referral scheduling time to 48-hours. The purpose of this quality improvement initiative was to develop a process to reduce referral scheduling time with a downstream impact of improving patient satisfaction.

Methods: An interdisciplinary team consisting of on-site clinicians, allied-health staff and practice managers, in addition to scheduling staff in our own practice and at referral practices met three times over a period of 6 weeks. Each meeting lasted between 4 and 7 hours. To understand the current workflow to allow for process improvement, we used the Lean Six Sigma DMAIC methodology (Define, Measure, Analyze, Improve, Control). Data was collected at baseline and at follow-up, including number of external referrals by month, number of days to triage referral, contact patient, and close referral, number of days from referral to appointment date, percent of 3^rd calls that result in a scheduled appointment, and patient satisfaction on question regarding ease of scheduling.

Results: New referral scheduling dropped to less than two business days and the percent of patients rating the scheduling experience as excellent rose to 82% after process changes. Baseline process evaluation allowed us to identify considerable areas of waste including: a section-specific referral form; secretaries calling new patients up to three times prior to closing a referral when 3^rd calls never resulted in an appointment being scheduled; a physician triage system resulting in batching of referrals and delays in scheduling; and secretaries hand-writing demographic information on a pre-appointment checklist.  Our methodology led to the implementation of three process changes: non-urgent referrals were scheduled with the first available provider to eliminate scheduling delay due to the triage process; an electronic smartphrase eliminated the need for handwritten information and was embedded into the electronic referral containing a prior pre-appointment checklist; elimination of requiring all clinical documentation to be on hand prior to appointment scheduling but incorporated a secretarial electronic checklist to ensure all documents arrived prior to the patient’s scheduled appointment.

Conclusion: Using quality improvement methodologies allowed the Section to initiate low-cost modifications to existing workflows to reduce overall scheduling times and improve patient satisfaction.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/use-of-lean-six-sigma-methodology-to-improve-time-to-scheduling-for-new-patient-referrals-to-rheumatology/