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Quality Improvement/Patient Safety: Primary & Subspecialty Outpatient Quality Improvement

QI 6: Primary & Subspecialty Outpatient QI Group 1

263 - Improving Same Day Access in Pediatric Primary Care

Monday, May 1, 2023

9:30 AM – 11:30 AM ET

Poster Number: 263
Publication Number: 263.452

Eric W. Glissmeyer, University of Utah School of Medicine, Bountiful, UT, United States; Carole H. Stipelman, University of Utah School of Medicine, Salt Lake City, UT, United States; Zi Sheng He, University of Utah School of Medicine, South Salt Lake, UT, United States; Alexis R. Olivas, University of Utah School of Medicine, Salt Lake City, UT, United States; Jason M. Fox, University of Utah School of Medicine, Salt Lake City, UT, United States; Jennifer M. RIgby, University of Utah, Salt Lake City, UT, United States; Justin Alvey, University of Utah School of Medicine, Salt Lake City, UT, United States; Howard Kadish, University of Utah School of Medicine, Salt Lake City, UT, United States

Presenting Author(s)

Eric W. Glissmeyer, MD, MBA

Associate Professor of Pediatrics
University of Utah School of Medicine
Bountiful, Utah, United States

Background: Preventive care visits have increased for US children, reducing access for problem-based visits and shifting same day availability to other venues. In-house collaboration with pediatric emergency medicine providers within primary care may increase access for urgent illness or injury, hospital follow-up, and bilirubin management.

Objective: To increase acute care access within pediatric primary care.

Design/Methods: The Same Day Pediatrics clinic was established at a community health center with in-house laboratory, radiology, and pharmacy within a system of 30 primary care clinics. We staffed 7 shifts/wk (1-2 shifts/d; 3 visits/hr, 4 hr each) with 12 pediatric emergency medicine providers from 7 AM to 7 PM. Appointments were opened for centralized scheduling from inbound calls 3 days prior to the visit. A general electronic health record (EHR) (EPIC, Verona WI, USA) message guided the scheduling by chief complaint. Process changes in phase 1 (8/1/22-9/7/22) included creating EHR templates with quick buttons, provider EHR training, and training centralized schedulers. In phase 2 (9/8/22 – 12/8/22), we changed from scheduling under a generic provider to provider name and opened the schedule to all visit types. Changes in proportions of slots filled per day were compared between phase 1 and 2 using chi-squared. We used statistical process control (SPC) was used to assess for special cause variation, and interrupted time series (ITS) to assess for trend.

Results: 1422 available acute care visit slots were created. The proportion of slots scheduled increased from phase 1 (39%) to phase 2 (87%; P < .001). SPC showed special cause variation > 3 SD above the mean associated with scheduling under provider name and opening scheduling to all visit types. ITS trend for proportion scheduled increased (1.9 %/week, P ≤ 0.001) in phase 1 and (0.3%/week, P = .002) in phase 2 (Figure).

Conclusion(s): Same day patient access was increased in a primary care setting partnering with pediatric emergency medicine providers. Generic template providers and visit type restrictions were associated with poor fill rates and should be avoided.