Background and Introduction

1. Impact of a revised appointment scheduling script on IUD service delivery in three Title X family planning clinics Stephanie Mistretta MA1, Summer Martins MPH1, Brittany Betham MD1, Jane L. Holl MD MPS2, Melissa Gilliam MD MPH1 1University of Chicago, Department of Obstetrics and Gynecology, Section of Family Planning & Contraceptive Research 2Northwestern University, Feinberg School of Medicine, Center for Healthcare Studies Discussion Results Background and Introduction Standardizing the IUD scheduling call script was a simple, yet effective intervention aimed at addressing both clinical and administrative outcomes in the Title X setting. This type of intervention may be beneficial as it is easily replicable, scalable across diverse settings, and requires minimal staff and administrative time to design, train and implement. Implementation of a standardized call script may increase the efficient use of clinical resources, thereby furthering IUD service delivery outcomes. Further evaluation, including a complete post-intervention FMECA analysis, may yield additional information about new or ongoing failures in IUD service delivery. Continual dynamic evaluation is necessary to ensure such an intervention remains accurate, useful and engaging. Women aged 15-25 are at high risk of unintended pregnancy, yet they have the lowest rates of IUD use. The appointment scheduling call represents a first line opportunity to improve and set a standard for clinical service delivery. Though an emerging area in the healthcare field and widely utilized in other areas of industry, very little research has been done to evaluate the processes and systems that govern IUD service delivery. As part of a larger project using systematic evaluation of service delivery, this study evaluated the clinical and administrative impact of a standardized call scheduling script for IUD appointments at three Title X clinics in Chicago. • Across both data collection period, we collected data from a total of 99 scheduled appointments. Data were collected in aggregate and stratified by age group: (1) age 25 or younger (n=51) and (2) over age 25 (n=48). • Primary findings include: • The revised script decreased no-show rates overall with 40.4% of patients failing to attend the scheduled appointment before the script vs. 23.8% after the script (p=.08) • Significant differences were seen in the no-show rates of women age 25 or younger (46.9% vs. 15.8%, p=.04) • Among women who attended their appointment, there were no differences among women eligible to receive their IUD (97.1% vs. 90.3%, NS) or completed IUD insertions (79.4% vs. 78.1%, NS) Methods • We employed the Failure Modes Effects and Criticality Analysis (FMECA) risk assessment technique to identify systems failures in IUD service delivery. • This evaluation revealed several “high risk” failure areas in service delivery during the preclinical and clinical phases of a planned IUD insertion: • Patients arrived at the clinic having had unprotected sex in the weeks prior to the scheduled appointment • Patients were unaware of clinical policies including basic administrative information and IUD-specific requirements • Patients frequently cancelled or “no-showed” for appointments • To address these issues, we created a revised IUD scheduling script using a standardized, color-coded, streamlined flowchart design • Evaluation of the script utilized a pre-/post-study design: • Data were collected on attendance, IUD eligibility and IUD insertion completion for two three-week periods at all three Title X clinic sites in November 2012 and January 2013 • In between the data collection periods, we trained the call center staff on the new script and provided both electronic and hard copy reference materials References Coles G, Fuller B, Nordquist K, Kongslie A. Using failure mode effects and criticality analysis for high-risk processes at three community hospitals. JtComm J Qual Patient Saf. Mar 2005;31(3):132-140. Coles G, Young J. Use of Failure Modes Effects and Criticality Analyses to Improve Impatient Safety. Safety Analysis and Risk Assessment Division of the 2002 ASME International Congress and Exposition. New Orleans, LA2002. Lieberman P. Design failure mode and effects analysis and the industry. Automotive Engineering (AUTE). 1990;31. Cohen MR, Senders J, Davis NM. Failure mode and effects analysis: a novel approach to avoiding dangerous medication errors and accidents. Hosp Pharm. Apr 1994;29(4):319-330. Fletcher CE. Failure mode and effects analysis. An interdisciplinary way to analyze and reduce medication errors. J Nurs Adm. Dec 1997;27(12):19-26. McNally KM, Page MA, Sunderland VB. Failure-mode and effects analysis in improving a drug distribution system. Am J Health Syst Pharm. Jan 15 1997;54(2):171-177. Scanlon M. Use of Failure Modes and Effects Analysis to Evaluate the Introduction of Variation to a Medication Infusion Preparation Process through Regulatory Standardization. Boston, MA: 6th Annual National Patient Safety Foundation Congress;2004.