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Convenient Cardiology Consult Clinic

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by

Cherise Paulk

on 1 February 2016

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Transcript of Convenient Cardiology Consult Clinic

C
The C Team
When to Use C4
Background
Proposal/ Purpose
Value Stream Analysis
Clinic Needs
Green Belt Tools
Challenges
Results
Future
Background

Reduce wait times

from 42 days (average wait time for new consult) to < 1 day

Reduce anxiety

amongst Veterans caused by extended wait times

Streamline

process for
referring
providers

Optimize test ordering
and utilization process

Improve access
to care
Proposal
Purpose
Veteran Centered
Convenient Cardiology Consult Clinic ( C )
Lean Tools Used for Improvement
Timeline
Lean Tools Used for Improvement
Lean Tools Used for Improvement
Failure Mode & Effects Analysis
(FMEA)
Lean Tools Used for Improvement
Daily Huddle - Plus/Delta
Quick Hits
Real Time Changes
Highlights & Results
Access
Completed Consult Volume
Cost Analysis
Lower Burden on Veteran
Community Satisfaction
Challenges
Slow Start
Delays due to staffing needs of clinic
Knowledge of clinic and availability
Resistance to change
Conversion of admin space to clinical space
Equipment
Waiting room
Contributors to Success
Aimed for ideal state
Invested team members

Data was readily available

Stakeholder support

Leadership support

External Feedback

Future Direction
“Delays for access to care plague our healthcare systems. These
delays
cause
patient

dissatisfaction
, contribute to staff dissatisfaction, and may lead to
worsening clinical outcomes
. They are also
expensive
: patients often consume scarce resources while waiting, there is a cost in maintaining any waiting list; the longer the wait the higher the “
fail to show
” rate, which represents
unused capacity
; and, finally, there is the risk that patients waiting will arrive with a
more costly clinical condition
.
Improving access involves looking at system flexibility or capacity
.”


British Medical Journal Jun 10, 2000; 320(7249): 1594–1596.Murray, M.
Clinic Needs
for Success
Staffing
3 Cardiologists
1 RN
1 HAS clerk
Equipment
Exam Tables
Computer on Wheels
EKG Machine
Blood Pressure Cuffs
Do Not Disturb Signs
Chart Holders
Magazine Racks
Chairs
Space
Create check in area
Create waiting room
Create exam rooms
Clinic Infrastructure
Develop scheduling grid
Create consult template
Adjust existing consult clinics
Obtain VistA access keys for new clinic
Create Outlook mail group
Set up group pagers
Risk
Mitigation
Back up plan for coverage
Develop no show process
Develop after hours process
Education
Trial run with test patients
Inform surrounding clinics of changes
Educate referring providers of new process
Reduced Wait Time
Access
42 Days
< 1 Day
C
onvenient
C
ardiology
C
onsult
C
linic

Avoidable Costs
Slow Start
Consult Volume During Pilot
Completed Consult Volume
Veteran Population &
Utilization Increasing
The VA-enrolled veteran population has
increased by 78%
from FY2001 to FY2014.

Since FY2003, 63%–65% of VA enrolled veterans have used VA health care each year.

As a proportion of the total veteran population, the VA-enrolled veterans have increased from 20% in FY2001 to
42% in FY2014
.

Green Belts: Cherise Paulk & Janelle Perritte
Black Belt: Joann Fennichia
Champion: Dr. Mazhar Afaq
Team Members: Dr. Anna Paszczuk, Dr. Dennis Hall, Bill Sherer, & Maida Kelly
The Word is Spreading!
C
C
Process Map for C
“Excellent caring team- we felt like the red carpet was rolled out for the care. Feeling confident. Bill, [RN] was super to us.”
“Keep on doing what you are doing!”
“Couldn’t believe how quick it was for us to be seen by a Cardiologist.”
Caregiver: "“This was the most pleasant visit this Veteran and I have ever been a part of.”
Happy Happy Happy :)
“Was treated very well. Outstanding Dr. Afaq & Maida Kelly. Outstanding Cardiology Consultation. Great Job!
“Doctor put Cardiology Clinic request in and the Clinic was able to see me quickly and staff was very personable and professional. Thank you!”
Agenda
No-
Shows
Scheduling errors and scheduling process
Not Veteran centric
Incorrect demographics
Distance patient had to walk
Signage not clear
Challenges Before C
Clinic not centralized
Workaround- Volunteers calling patients

$7,265.35
total Cost of inappropriate tests from Feb 2013 sample


Tests ordered inappropriately

A February 2013 sample of 30 patients revealed that 6 Echo, 5 Nuclear Stress Tests, and 3 Holter tests were ordered by referring providers when these tests were not needed by Cardiologists. It was found that Stress Tests were being ordered appropriately.

$335,498
projected cost avoidance over a fiscal year

$12,543
Cost Avoidance in the C4 pilot
(30 patient sample)

Cost Analysis

4
4
4
4
4
4
4
Suboptimal tests ordered by referring provider
Cost of ARNP reviewing appropriateness of consults
Plattsburg, Missouri
From March 2014 - August 2014
84 No-Shows in Cardiology Consult Clinics,
76 in traditional and 8 in C4
Full transcript