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Implementation of a Quality Improvement Project in a Pulmonary Clinic Enhances Efficiency, Wait Times and Financial Productivity
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A1475 - Implementation of a Quality Improvement Project in a Pulmonary Clinic Enhances Efficiency, Wait Times and Financial Productivity
Author Block: S. Ossowski1, P. C. Giri2; 1Internal Medicine, LLUMC- Internal Medicine, Loma Linda, CA, United States, 2Pulmonary and Critical Care, Loma Linda Univ Med Ctr, Loma Linda, CA, United States.
RATIONALE: Efficiency in an outpatient clinic setting affects patient health, satisfaction and clinic costs1. The Pulmonary Clinic at Loma Linda University had very high wait times for clinic appointments and inefficient clinic visits. A pulmonary clinic Quality Improvement Project (QIP) was instituted from July 2015 to December 2016 and data was analyzed pre- and post- QIP implementation.
METHODS: Patient flow was mapped and time required for the following during a clinic visit were recorded: check in, lobby wait, nurse check in, wait for physician in exam room, physician face-to- face and wait to check out along with time for first available pulmonary clinic appointment. The Pulmonary Division met as a group in July 2015 to review data, identify areas of improvement using a cause and effect diagram and outline targets and methods of achieving them2. Patient satisfaction score and physician financial productivity were recorded. The QIP included the following: a) standardization of clinic visit templates, notes and preference list orders for all physicians, b) chart preparation done by clinic staff, c) improved in-clinic orders, d) Electronic Medical Record experts’ involvement in creating efficient work flow. There were no changes in physician or staff numbers during the process.
RESULTS: A total of 245 clinic visits were randomly studied: 99 pre-QIP and 146 post-QIP implementation. The overall encounter time for return patients decreased by about 15 min, p=0.01. First available clinic appointment decreased from 12 weeks for new visits and 8 weeks for return visits to 2 weeks for both post-QIP. There was a significant difference in the following post-QIP: a) time to check in for new patients (decreased by 1.7 min, p=0.05), b) returning patients’ time waiting for physician in exam room (decreased by 4 min, p=0.04), c) wait time to begin check out (decreased by 3 min for return visits, p=0.04 and 6 min for new visits, p=0.04). Patient satisfaction survey scores showed significant improvement in many areas. Financial productivity increased by 18% post- QIP.
CONCLUSIONS: Implementation of a quality improvement project in the pulmonary clinic of an academic center resulted in improved clinic efficiency, patient wait times and satisfaction scores and boosted financial productivity.
Author Block: S. Ossowski1, P. C. Giri2; 1Internal Medicine, LLUMC- Internal Medicine, Loma Linda, CA, United States, 2Pulmonary and Critical Care, Loma Linda Univ Med Ctr, Loma Linda, CA, United States.
RATIONALE: Efficiency in an outpatient clinic setting affects patient health, satisfaction and clinic costs1. The Pulmonary Clinic at Loma Linda University had very high wait times for clinic appointments and inefficient clinic visits. A pulmonary clinic Quality Improvement Project (QIP) was instituted from July 2015 to December 2016 and data was analyzed pre- and post- QIP implementation.
METHODS: Patient flow was mapped and time required for the following during a clinic visit were recorded: check in, lobby wait, nurse check in, wait for physician in exam room, physician face-to- face and wait to check out along with time for first available pulmonary clinic appointment. The Pulmonary Division met as a group in July 2015 to review data, identify areas of improvement using a cause and effect diagram and outline targets and methods of achieving them2. Patient satisfaction score and physician financial productivity were recorded. The QIP included the following: a) standardization of clinic visit templates, notes and preference list orders for all physicians, b) chart preparation done by clinic staff, c) improved in-clinic orders, d) Electronic Medical Record experts’ involvement in creating efficient work flow. There were no changes in physician or staff numbers during the process.
RESULTS: A total of 245 clinic visits were randomly studied: 99 pre-QIP and 146 post-QIP implementation. The overall encounter time for return patients decreased by about 15 min, p=0.01. First available clinic appointment decreased from 12 weeks for new visits and 8 weeks for return visits to 2 weeks for both post-QIP. There was a significant difference in the following post-QIP: a) time to check in for new patients (decreased by 1.7 min, p=0.05), b) returning patients’ time waiting for physician in exam room (decreased by 4 min, p=0.04), c) wait time to begin check out (decreased by 3 min for return visits, p=0.04 and 6 min for new visits, p=0.04). Patient satisfaction survey scores showed significant improvement in many areas. Financial productivity increased by 18% post- QIP.
CONCLUSIONS: Implementation of a quality improvement project in the pulmonary clinic of an academic center resulted in improved clinic efficiency, patient wait times and satisfaction scores and boosted financial productivity.
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