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A Rapid Cycle Improvement Approach to Increase Patient Readiness at Their Scheduled Appointment Time

Cowdell, Jed Colt, MD, MBA; Smoot, Teresa B., MSN, RN, NE-BC; Murray, Loren P., MD; Stancampiano, Fernando F., MD; Hedges, Mary S., MD

doi: 10.1097/QMH.0000000000000194
Quality Improvement

Background: Patient unpunctuality negatively affects quality care. We found that 39% of patients at an academic primary care center were not ready to be evaluated at their scheduled appointment time. Our aim was to reduce this to 20% in 3 months' time.

Intervention: A multidisciplinary quality improvement team utilized quality improvement tools and methodology to determine that patient punctuality was a major modifiable factor contributing to the care gap. Reforming the scheduling process to include a built in 15-minute early arrival was implemented for acute visits for a 2-week trial period. Based on the successful results, this was then disseminated to all appointment types for a 3-month trial.

Results: Of the 182 patients seen during the 2-week trial period, 34 (19%) were not ready to be seen at the time of their appointment, a 20% improvement (P value < .001) from baseline. A total of 2832 patients were followed up for all visits during the next 3 months and 590 (21%) were not ready on time (P value < .001). Physician and patient satisfaction results improved after the intervention.

Conclusions: Utilizing quality improvement tools we were able to find a simple and inexpensive intervention to improve patient punctuality as well as patient and provider satisfaction.

Division of Community Internal Medicine, Mayo Clinic, Jacksonville, Florida.

Correspondence: Jed Colt Cowdell, MD, MBA, Division of Community Internal Medicine, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224 (

The authors thank Terrance Dawkins, LPN, Dorothy McDaniels, and Anna Walker.

The authors declare no conflicts of interest.

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