Ambulatory redesign: Strategies for quality improvement in patient care.

85 Background: Growing outpatient volume poses patient flow challenges, making it difficult to accommodate the complexities of academic medical practice. Volume increases create operational inefficiencies like delays in lab turnaround time (TAT) and limited rooming capacity resulting in delays in patient access and reduced provider productivity. These bottlenecks negatively impact patient satisfaction.

METHODS: Four multidisciplinary teams assessed barriers to patient flow in the lab, rooming and scheduling process. We sought to maximize the Advanced Practice Provider (APP) role within clinical programs. Each team was led jointly by an MD and RN and included subject matter experts, advisors and facilitators. The groups met regularly for 2 months to evaluate operational data, national benchmarks and surveyed staff. Monthly progress was presented during the Ambulatory Clinic Committee (ACC) meetings. Number of labs not completed on time, wait-time and APP visit volume were tracked.

RESULTS: Recommendations included provider education on lab order process, purchasing a second instrument for chemistries, APP independent visits standards, and realistic scheduling times. Preliminary findings indicate that the lab reduced their average TAT defect rate by 52.3% (CBC) and 76.1% (CMP) compared to January 2014 (baseline) and January 2015 (post implementation). This difference was statistically significant at a 95% CI, with p < .001 for both CBCs and CMPs. In addition, APP total visit volume increased by 81% from FY 2014 to FY 2015. Finally, the overall Press-Ganey mean in patient satisfaction with physician wait time increased from 81.7 to 82.7 (2014 vs. 2015).

CONCLUSIONS: Multidisciplinary teams recommended valuable process improvement changes to reduce the TAT in the lab and to promote that APPs work within the full scope of their license. Implementation requires extensive project management support and continuous tracking to evaluate outcomes. Opportunities exist to maximize space and room utilization and optimize the scheduling process as the outpatient volume continues to increase.