A Quality Improvement Intervention to Increase Access to Pediatric Subspecialty Practice

Pediatric Endocrinology and Diabetes.
PEDIATRICS (Impact Factor: 5.47). 01/2013; 131(2). DOI: 10.1542/peds.2012-1463
Source: PubMed


To improve access to new pediatric endocrinology appointments in an urban academic hospital faculty-based practice.

Three strategies were implemented to increase the number of appointment slots: new patient appointments were protected from conversion to follow-up appointments; all physicians, including senior faculty, were scheduled to see 3 to 4 new patients per session; and sessions devoted exclusively to follow-up appointments were added based on demand. The main outcomes for this quality improvement activity were waiting times for new and follow-up appointments, monthly visit volume, the per-provider visit volume, differences in the proportion of new visits, and clinic arrival rates pre- and postintervention.

Thirteen months after the intervention, average wait for a new patient appointment decreased from 11.4 to 1.7 weeks (P < .001) and follow-up appointment wait time decreased from 8.2 to 2.9 weeks (P < .001). Mean monthly total visit volume increased from 284 to 366 patient visits (P < .01) and mean monthly visit volume per provider increased from 36.8 to 41.0 patients (P = .08). New patients were 27% of the visit volume and 35% after the intervention.

Access to our pediatric specialty care clinic was improved without increasing the number of providers by improved scheduling.

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    ABSTRACT: Missed appointments ("no-shows") represent an important source of lost revenue for academic medical centers. The goal of this study was to examine the costs of "no-shows" at an academic pediatric neurology outpatient clinic. This was a retrospective cohort study of patients who missed appointments at an academic pediatric neurology outpatient clinic during 1 academic year. Revenue lost was estimated based on average reimbursement for different insurance types and visit types. The yearly "no-show" rate was 26%. Yearly revenue lost from missed appointments was $257,724.57, and monthly losses ranged from $15,652.33 in October 2013 to $27,042.44 in January 2014. The yearly revenue lost from missed appointments at the pediatric neurology clinic represents funds that could have been used to improve patient access and care. Further work is needed to develop strategies to decrease the no-show rate to decrease lost revenue and improve patient care and access. Copyright © 2014 Elsevier Inc. All rights reserved.
    Pediatric Neurology 10/2014; 52(2). DOI:10.1016/j.pediatrneurol.2014.10.020 · 1.70 Impact Factor

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