PD10-12 IMPLEMENTATION OF THE THREE E’S (EFFICIENCY, EDUCATION, AND E-CONSULTS) TO IMPROVE UROLOGY ACCESS WITHIN THE VETERANS HEALTH ADMINISTRATION

Abstract

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Quality Improvement & Patient Safety III1 Apr 2016PD10-12 IMPLEMENTATION OF THE THREE E’S (EFFICIENCY, EDUCATION, AND E-CONSULTS) TO IMPROVE UROLOGY ACCESS WITHIN THE VETERANS HEALTH ADMINISTRATION Matthew Uhlman, Savanah Lakose, Dena Dietzler, Joseph Cullen, and Bradley Erickson Matthew UhlmanMatthew Uhlman More articles by this author , Savanah LakoseSavanah Lakose More articles by this author , Dena DietzlerDena Dietzler More articles by this author , Joseph CullenJoseph Cullen More articles by this author , and Bradley EricksonBradley Erickson More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.2920AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The purpose of the study was to evaluate early outcomes from the specialty and surgical care collaborative (SCC) initiated within the Iowa City Veterans Health Administration (VHA) Department of Urology which aimed to decrease veteran wait times. We hypothesized that simultaneous implementation would significantly improve access to both clinical and procedural urologic care METHODS In January of 2015, our VHA urology department was notified of significant deficiencies in our next available consultations (>80 days) and next available cystoscopy (40 days) wait times. We collectively sought to address these wait times without having the ability to increase urologic work-force and thus enrolled in the SCC. Three strategies were simultaneously employed: 1) Efficiencies: Utilization of clinic time was examined and clinic templates were overhauled to allow for more new visits. Non-surgical and non-emergent urologic follow-up care was triaged to primary care providers and consults for surgery that don’t require anesthesia (e.g. vasectomy) were completed on the phone. 2) Education: We revised an implemented a new primary care consult template based directly from AUA guidelines to empower primary providers to manage secondary urologic care (e.g dual medical therapy for benign prostatic hyperplasia, ordering of radiology/cytology for hematuria work-up). For patients requiring urology consults based on templates, required pre-consult work-up was outlined. 3) E-consults: Questions regarding urologic care in which primary provider is unsure about need for consult could be directed to urology without formal consultation. E-consults were triaged by urology and recommendations for care were provided. RESULTS After implementation of the 3-Es, we decreased our clinic wait time for new consults from 80 days to 30 days (62.5% reduction) and our cystoscopy wait time from 40 days to 11 days (73% reduction). At present, greater than 90% of new patients are seen within 30 days of a consult request. Revised templates have allowed us to see an additional 10 patients per day without the need to increase work-force. To date, 65 E-consults have been completed, only 10 (15%) of which required formal consult. AUA guideline directed templates have decreased our BPH consults by 20%. We estimate that these modifications have effectively added 6 additional clinic days during the 10-month study period. CONCLUSIONS Implementation of these simple measures has dramatically and quickly decreased wait times for urologic consultations in our VHA. This increase in access has come only as a result of increased support by our VHA primary care colleagues and might only be cost-effective in a non fee-for-service model such as one found in the VHA. However, with urologic access issues being a concern nationwide, this model may become useful even for fee-for-service practices as our workforce continues to diminish. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e244 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Matthew Uhlman More articles by this author Savanah Lakose More articles by this author Dena Dietzler More articles by this author Joseph Cullen More articles by this author Bradley Erickson More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...