Abstract 333: Design and Implementation of a Pediatric Outpatient Cardiology Clinic Renovation Utilizing Quality Improvement Methodology

Abstract

Background: With increasing pressure to manage medical resources prudently, quality improvement methodology can be utilized to increase efficiency and decrease cost in current outpatient cardiology clinic operations. However, there are few examples of quality improvement methodology applied to the design, implementation and management of a renovation project aimed at meeting a five year projected volume increase of 155% and multidisciplinary clinic expansion. We hypothesized that by using quality improvement methodology, the increasing volume demands could be met by improving clinic flow and thus maintain patient access while reducing medical resource expansion. Methods: Outpatient cardiology clinics and testing functions were assessed for clinic visit volumes and duration, testing volumes and durations, patient no show rates, the number of provider clinic hours, room utilization, scheduling template design and accuracy, and the scheduling process. Baseline assessments were made prior to process improvement efforts. A series of interventions were made as follows: modification of the patient follow up scheduling process, reduction in the number of scheduling templates, modification of templates to include pre visit nursing and electrocardiographic acquisition time, change from half day to all day clinic templates, pre visit registration, limiting of exam room assignment to a maximum of 3 per provider and spread of the clinic across 5 days per week. Results: Baseline data revealed a 43% no show rate, room utilization was 34%, patient access defined by lag days between first contact and appointment was 22 days. These metrics indicated that the number of exam rooms needed to meet our projected volume increase would result in an increase from 10 to 30 rooms. Two years into our interventions and our no show rate is 6%, room utilization is 68%, patient access has improved with lag days at 10. These improvements have occurred in the presence of an 18% annual volume increase, an increase of 5% in patient provider hours and an exam room increase from 10 to 23. Conclusions: Process improvement methodology applied to room utilization, patient scheduling, provider staffing patterns and clinic visit templates can be successfully utilized to design and implement an outpatient cardiology clinic renovation. If properly applied, process improvement can be a method to maximize the use of current and future medical resources while insuring patient access to services.