The Radiation Oncology team from the University of Colorado was led by Arthur Liu, MD and Melissa Feig.
The team set out to tackle problems with patient access. They realized that their time from referral to first visit was close to 10 business days. This often meant that patients were waiting weeks to be seen. The team set a goal of reducing the wait time to 5 days. Along with Bryan Gomez, a process improvement consultant and Molly Lane, a data analyst within the IHQSE, the team set out to do detailed process mapping of patient flow into the clinic. They quickly discovered that the process contained inefficiencies on both the front- and back-ends of the process.
Front End Process Change
Working with the front-office staff, the team identified several key bottlenecks in the process. First, they identified multiple ways in which consultations could come to the clinic. This included both Epic orders, emails, phone calls and even sticky notes on desks. The team standardized this through a single process in Epic. Next, the team discovered that patients who could not be reached to schedule an appointment often weren’t called back for several days. They established a policy of repeat phone calls the next day.
Small Change, Huge Benefit
These small changes resulted in significant improvement in patient flow. The average time from referral to first contact fell dramatically within weeks of the change, from 2.4 days to 1 day. Likewise, the average time from referral to appointment made dropped from 4.4 days to 2.5 days. Nearly a year after the intervention, the benefit has been sustained with average patient contact time of 1.5 days and time to appointment of 2.6 days. These changes have combined to reduce the overall time from referral to appointment from 9.6 days to 8.1 days.
While still short of their goal, these changes have resulted in significant access and financial benefits. The number of new referrals, flat for nearly 5 years, rose dramatically in the year since the intervention. The clinic is now seeing 24 percent more patients per month than they were seeing prior to the intervention. This volume is being handled without an increase in physician or provider staffing.
Inspired by their early successes, the team continues to refine the front end processes. After a few months of regression due to some front-office staffing issues, the team is back on track with the recent month showing the best wait times yet. The team, along with Department leadership, is now working to revise physician templates to create more space for patients. “The goal is to reliably have space on a doctor’s schedule to get a patient in within 5 days,” says Dr. Liu. This can be challenging because many patients require a particular specialist who may not have availability in that timeframe. The team is looking to overcome this by pairing specialists and ensuring that at least one of them has clinic openings each day of the week.
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