Session Title: Quality Measures and Quality of Care Poster Session
Session Type: ACR Poster Session C
Session Time: 9:00AM-11:00AM
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 3rd 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 3rd 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.
To cite this abstract in AMA style:Orzechowski N, Bolg M, Bergeron R, Dorman C, Sanderson L, Stark M, Wilk S, Gray T. Use of Lean Six Sigma Methodology to Improve Time to Scheduling for New Patient Referrals to Rheumatology [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/use-of-lean-six-sigma-methodology-to-improve-time-to-scheduling-for-new-patient-referrals-to-rheumatology/. Accessed March 30, 2020.
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