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

graph_lomalinda_cardiology.gif

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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