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Improving Access to Dermatology Appointments in the Cancer Prevention Center

Enhancing access to urgent dermatology appointments in a cancer prevention center, reducing wait times and improving efficiency through targeted interventions and prioritization processes.

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Improving Access to Dermatology Appointments in the Cancer Prevention Center

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  1. Improving Access to Dermatology Appointments in the Cancer Prevention Center Carol Drucker, MD Margaret Bell, MPH

  2. Before the change….

  3. Problems Identified: • Time to first open appointment: 142 days • Patients with urgent problems were dealt with one by one, interrupting scheduler, nurse and doctor to look for a non-existent place in the schedule to put them. • Urgent problems were on an appointment "wait list." for 79 days • Clinics ran late routinely • No lunch for the doctors, overtime for the nurses, and dissatisfaction and stress for all. • Over 200 "missed appointment reschedules" were backlogged. • Temporary hold placed on “new” patients • Increased liability • Lost revenue opportunities • High patient dissatisfaction • High provider and staff dissatisfaction.

  4. Improving Access to Dermatology Appointments in the Cancer Prevention Center AIM: To decrease wait time for urgent appointments in Dermatology Cancer Prevention Center by 10% from July 2007 to December 2007

  5. Fishbone Analysis

  6. Develop a process working in patients with urgent problems Develop a process of differentiating appointment types Revamp the missed appointment process Potential Changes/Interventions

  7. Develop a process for working in patients with urgent problems • Restrict appointment in cancellation slots to a designated PSC • Develop a wait list with sufficient info to know who should be worked in • Develop a system of prioritizing of the patients with urgent problems on the urgent list • Develop tools for PSC/RN’s

  8. Patient Prioritizing Method

  9. New Prioritization Process • Patients prioritized to high/low risk by RN/MD • Form developed to communicate risk to PSC • Appointments types changed to accommodate risk

  10. List of High Risk Factors • Excessive sun exposure and/or sunburns • History of actinic keratoses • History of basal cell skin cancer • History of squamous cell skin cancer • Having over 50-100 moles • History of dysplastic (atypical) moles • History of melanoma • Family History of melanoma • Other

  11. Current Missed Appointments Process Current process : • Annual low risk screenings given same weight as high risk • Three phone calls to patient missing appointment by RN • PSC reschedules appointment up to 3 times • Business Center verifies insurance each visit • All patients given 15 minute appointment

  12. Televox • A patient call reminder system helped identify last minute appointment slots. “HOLES” Hi-Ho! Hi-Ho Off to work we go

  13. Missed Appt Process for RN

  14. MA Process Long Term

  15. Derm Appointment Types

  16. PSC Communication Tool

  17. New Process Instead of 3 calls and 3 reschedules: • Low Risk: Only letter without reschedule • High Risk: Letter reminder at risk with factors identified • Undiagnosed: Individually follow up by MD or RN.

  18. Appointment Type Reduced annual low risk savings by 23.9%

  19. Final Results • AIM: To decrease wait time for urgent appointments in Dermatology Cancer Prevention Center by 10% from July 2007 to December 2007. • RESULTS: • Improved by 91.14% • Access less than 48 hours for urgent patients • Urgent wait list gone

  20. Why go through the effort?

  21. Gross Annualized Revenue *Based on a rate of 6% although average cancer diagnosis in center is 14.4% (to be conservative with projections as percentage of patients treated here is not known). In addition, lowest institutional estimates for cancer diagnosis treatment cost were utilized as patients are generally diagnosed at an earlier stage (a mix of 50% breast in situ, 45% simple melanoma and 5% colon. ** Based on 2 biopsies per patient. Generally new patients average 3-4 or higher. Does not include photography charges, extensive procedures or Cryosurgery. *** EIW was data source and institutional charge master was source for charge estimates.

  22. Sustaining the Gain “What ultimately makes any project sustainable is local ownership from the beginning in designing the project, establishing the priorities.” James - Rebviltlraq Projects Found Crumbling NY Times. Sun 29 Apr07

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