3Q's for QI | Q&A with Dr. Alexandria Wiersma
Dec 20, 2024
Quality improvement experts at Children’s Hospital Colorado, including Dr. Sandra Spencer (IHQSE Faculty) and Dr. Alexandria Wiersma (IHQSE Graduate), developed a novel fast-track model, typically seen in emergency departments, and implemented it in an urgent care. The initiative resulted in a 74% reduction in door-to-provider time and 36% reduction in urgent care length of stay. The fast-track process also continued to function and reduce door-to-provider and urgent care length of stay times during a large volume surge. This work is the only project involving the implementation of a fast-track model in a dedicated urgent care setting. We spoke with IHQSE graduate Dr. Alexandria Wiersma about key takeaways from this project and how those findings can be used as a model for other urgent care settings.
1. Tell us about your approach to this project?
We saw a rapid increase in urgent care patients after the COVID pandemic. This led to increased wait times, increased time to provider, and increased overall length of stay in the urgent care. We knew, from our own and other institution’s experiences, that emergency room fast track demonstrates improvement in all these measures. We thought we could take that process and utilize it in our urgent care. Utilizing the DMAIC framework, we addressed four major barriers: physical space need, staffing resources, fast track patient criteria, and patient follow through the facility and EHR. By addressing each of these, we were able to decrease length of stay and time to provider, even in times of high patient volumes.
2. Why is this work important?
Length of stay and time to provider are key metrics for patient satisfaction and patient safety. Improvements in both, as seen in this project, are highly valued by staff and patients alike. Utilizing an existing process (Fast Track) in a unique setting (urgent care) capitalizes on staff and provider knowledge, local processes, and evidence in the literature. We had success in both our urgent care setting and, interestingly, our co-located emergency department. Considering that time to provider and length of stay is likely more critical in an emergency department, this represents a double win for the project.
3. How do you think this will impact healthcare?
With increasing volumes and frequent staffing fluctuations, urgent cares and emergency departments need to be nimble and utilize efficient process. Other urgent care settings may choose to implement a fast-track model, which may improve time to provider and total length of stay.
Read the full article from the Journal of Urgent Care Medicine