
Improvement Report: Improving Access to Orthopedic and Cardiology Appointments
Veterans Health Administration
Loma Linda, California, USA
Team
Jennifer Anderson, Medical Affairs Program Manager David Ferry, MD, Chief, Cardiology Section Philip Reiswig, MD, Chief, Orthopedics Section Philip Roos, MD, Chief, Medical Service David Copeland, Health Technician Paula Osborn, Medical Clerk Cheryl Redfern, Program Assistant Norma Moncrief, NP Dwight Evans, MD, Chief of Staff
Aim
Decrease the waiting time for new appointments in Orthopedics from a range of 200 to 300 days to 30 days, and for Cardiology from 42 to 14 days
Measures
Number of days to a new appointment in Cardiology
Number of days to a new appointment in Orthopedics
Changes
The most important changes made in the Cardiology Department include:
- Reviewed all incoming consults (new requests for cardiology care) to check for appropriateness and lack of needed information. The attending physician used this information to fix any deficiencies before scheduling the patient, which prevented delays in care, as well as the patient or physician’s time.
- Educated physicians who were requesting consults on appropriate referrals to Cardiology.
- Established referral agreements to make it clear what information referring physicians needed to complete prior to submission to Cardiology.
- Measured true demand and adjusted supply to meet that demand.
- Changed the restricted medication policy to allow primary care prescribing authority.
The most important changes made in the Orthopedic Department include:
- Hired a full-time Orthopedic section chief.
- Changed the start time of the Orthopedic hand clinic.
- Moved the postoperative clinic.
- Added new appointment slots.
- Changed the clinic staffing structure.
- Added Operating Room time and changed the first case policy.
- Convened a team meeting with a collaborative team.
Results

Summary of Results / Lessons Learned / Next Steps
- Reinforced the power of thorough review involving the actual working team to make changes and improvements.
- Evaluated the data points to assess needs and make changes.
- Needed more support staff for efficient clinic function.
- Needed adequate time for data collection and analysis.
- Implemented facility-wide policies and changes to improve clinic function.
Contact Information
Jennifer Anderson Program Manager, Surgery, Anesthesia, Audiology, and Dental Anderson.Jennifer@med.va.gov
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