Purpose: Access to subspecialty clinics is an extremely important healthcare issue for patient care, referring physicians, and downstream revenue. Over the past two years, our institution, like many others, has struggled with supplying optimal access to new patients. Therefore, a quality initiative was undertaken by the Division of Gastroenterology at the University of Missouri-Columbia (MU-GI) to meet a goal of >70% of new patients to be scheduled within 10 days.
Methods: A prospective quality improvement initiative was conducted from December 2012 to April 2013. All new patients referred to our outpatient GI clinics were monitored and recorded. Data from before December 2012 was retrospectively evaluated. A quality initiative was implemented by a new Director of Ambulatory Services (December 2012). In December 2012, a supply-demand analysis was performed. On December 5, an educational session to faculty and fellows regarding prolonged access times and adoption of an open access clinic model were performed. On December 26, a policy was created and implemented with all Patient Service Representatives (PSRs) to notify Director of Ambulatory Services if any new patient referred to MU-GI cannot be scheduled within 10 days. If a new patient cannot be seen within 10 days, one of three options was initiated which included: Referred provider to overbook their clinic, Director of Ambulatory Services to overbook his clinic, or the Director create a special clinic outside of normal clinic time to see the patient. In January 2013, an open access model was adopted and initiated at MU-GI. The number of new patients seen within 10 days and number of total new patients were recorded as percentage of new patients seen within 10 days with a goal of >70% being established and statistically compared using Fisher's exact test.
Results: From October 2011 to November 2012, a total of 2,478 patients were referred to MU-GI with 871 being seen within 10 days (35.1%) with the best being 47.7% in August 2012. After initiation of the quality improvement initiatives from January to April 2013, 726 of 938 (77.4%) referred patients were seen within 10 days which was a statistically significant increase from earlier (p<0.01). During this time, new patient access was improved ever month compared to baseline (79.9%, 87.6%, 90.6%, and 83.5%).
Conclusion: New patient access to subspecialty clinics can be improved with simple initiatives, staff education, and improved teamwork. This successful model may be used to meet the current and future new patient demand in GI and other subspecialty clinics.