Improving access to care with implementation of a virtual anemia clinic.

Abstract

113 Background: In 2022, our cancer center saw a rapidly rising number of new hematology consult requests, specifically for anemia. This increase created access challenges, especially for our regional hematology oncology practices, who see both malignant and benign consult diagnoses. Our enterprise target metric for assessing access is defined as “median of appointments within 7 days.” This metric was rapidly as far out as 15 days (YTD) in the hematology disease group briefly, therefore calling the leadership team to action. An additional concern was provider dissatisfaction from frequent add-on requests for consults and a pivot from an even split of hematology oncology patients to heavily classical hematology consults. Timely triage and assessment of anemia is necessary for identification of potentially serious underlying cancer diagnoses. Methods: Upon investigation, opportunities to improve patient access were identified as: 1) underutilized APPs; 2) scheduler turnover, communication barriers resulting in up to 30% of new patient slots going unused; 3) anemia consults scheduled at 60 minutes which typically take 30-45 minutes to complete; 4) patients are interested in a virtual appointment for non-oncologic consult diagnoses but scheduling these visit types has been challenging. An APP lead virtual only anemia clinic (VAC) was launched in Sept 2022. The clinic consisted of with five 45-minute consults per day. A decision tree was created to for efficiency and to assist in appropriate diagnoses scheduled. Biweekly huddles for quality assurance of patient care were initiated. No additional FTEs were required to initiate this clinic. Results: In 6 weeks, we were able launch the VAC with utilization strongly in the upper 90%. 5 APPs trained in anemia consults divided Monday-Friday with one virtual day per week. Follow up patients were scheduled in person at regional or main campus locations as indicated. The access metric for hematology consults improved from 15 days (YTD) to 8 (YTD) within the initial 6 months. More specifically, anemia consult diagnoses improved to less than 7 days almost immediately. Anecdotally, patients were satisfied with the appointment availability and care received. Patient experience scores for the participating APPs remained steady throughout the initial first 6 months and are continuing to be followed. Conclusions: A VAC is a potential way to achieve improved patient access to an anemia consult, further providing timely evaluation and treatment. Additional professional revenue that does not utilize physical space, caregivers, building facilities is a positive outcome, in addition to expedited triage, assessment, diagnosis, and treatment for anemia in straightforward and complex patients. There is an added benefit for patients who have an opportunity for virtual care such as quick access to care, decreased financial toxicity, and removal of barriers to care like transportation and taking time off work.