Dr. Curtis Turner, professor of pediatrics at the USA College of Medicine and medical director of the primary care division of the department of pediatrics, led the project.
“Patients need continuous care,” Dr. Turner said. “If we are unavailable to care for our patients, then they are seen in urgent care or emergency rooms and receive fragmented care. We also miss the opportunity to prevent issues if we are unable to perform well-child visits and immunizations.”
According to Dr. Turner, there was a need to conduct a quality improvement project because access to primary care was limited and a backlog of appointments was evident. “Both parents and providers were frustrated with the long wait to get appointments in a timely manner,” he said.
Over a span of 22 months, the USA Department of Pediatrics made several changes to decrease the amount of no-show acute-illness and well-child visits, increase the overall number of visits and improve scheduling.
The department utilized the Plan-Do-Study-Act (PDSA) tool to accomplish their goals. The PDSA cycle included developing a plan to test the change, carrying out the test, observing and learning the results, and determining what modifications should be made to the test.
To determine the most common reason for no-show appointments, the department administered a survey to patients in the office who had previously missed an appointment. “The major reason indentified from the questionnaire was that the appointments were usually made several months in advance and the patients simply forgot,” Dr. Turner said.
Each month, the department also gathered data from electronic medical records and billing software to determine the amount of no-show appointments. According to Dr. Turner, electronic health record data showed an increase in the number of appointment no-shows for each period of 30, 60, or 90 days in advance.
To help decrease the amount of no-show visits, the department changed their appointment policy. Now, patients are unable to make appointments more than six weeks in advance. This change resulted in an increase in the overall number of visits by 10 percent.
Overall, the quality improvement project was successful in meeting all of the improvement goals. “Before, we experienced a 30 percent no-show visit rate, and currently we are down to 18 percent,” Dr. Turner said. “The no-show rate for well-child visits also decreased from 50 percent to 25 percent.”
Dr. Turner said this project was beneficial for both patients and USA Health. “The changes in this pediatric clinic benefit the educational opportunities for our students and residents,” he said. “The morale for clerks, nurses, residents and faculty has also increased.”
Dr. Turner said the changes also caused an improvement in patient flow and scheduling, helping USA Pediatrics to become financially solvent. In addition, the project led to changes that were noted outside of the stated goals including fewer dropped phone calls, decrease in time to answer phone calls and better rate of medical record completion.
Multiple pediatricians with USA Physicians Group – Dr. Kari Bradham, assistant professor of pediatrics at the USA College of Medicine; Dr. Jennifer Cole, adjunct assistant professor of pediatrics at the USA College of Medicine; Dr. Rosina Connelly, associate professor of pediatrics at the USA College of Medicine; Dr. LaDonna Crews, associate professor of pediatrics at the USA College of Medicine; and Dr. Paola Maurtua-Neuman, assistant professor of pediatrics – also participated in the project.
Click here to learn more about the USA Department of Pediatrics.
