694 - Improving Resident Continuity

Poster Number: 694
Publication Number: 694.152

Lauren K. Palicki, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States; Cynthia Rand, University of Rochester, Golisano Children's Hospital, Rochester, NY, United States

Background: Continuity in patient care in residency training is an essential component in the outpatient setting, as it optimizes patient care and provides a foundational learning experience for residents. However, continuity in the continuity clinic at Golisano Children’s Hospital Pediatric Practice (GCHPP) is noticeably lower than average (13% compared to studies that have shown rates of 33-84%). Increasing continuity has the potential to improve resident satisfaction and patient outcomes. In 2021 there was significant turnover and shortages of staff who schedule patients in GCHPP.

Objective: To improve resident continuity at GCHPP by 10% from November 2021 to June 2022. This is part of an ongoing study that began in 2018. We define continuity as residents having a patient on their schedule that they have seen at least one time previously in clinic.

Design/Methods: Data was collected during afternoon huddle prior to the start of clinic intermittently since 2018. In addition to the QI team meeting with the practice manager and front desk staff, residents were encouraged to self-schedule patients for follow-up (or mark on the discharge note exact dates for the staff to schedule follow-up, beginning in 9/2020). In 3/2022, Team Information Half Sheets were distributed to families at the end of a visit (Fig 1). The handout was double sided, listing names of team providers on one side with pictures of team members on the other. Providers were encouraged to check off their name and give patients these sheets to encourage families to recognize and schedule follow-up appointments with them. We analyzed data by calculating the percent continuity in each time period, and with a run chart (Fig 2) to display percentage of continuity over time.

Results:

22 residents’ schedules were reviewed in each time period. The rate of continuity increased by 9.6% overall from 11/2021 - 6/2022, with 20.8% of patients seen previously by the residents in 6/2022 (Table 1). The run chart shows this improvement, as well as an increase in continuity after 10/2020 when self-scheduling/discharge notes were implemented; continuity declined in 5/2021, likely in part due to short staffing.

Conclusion(s): Residents self-scheduling along with the introduction of Team Half Sheets improved continuity in GCHPP. Next steps include decreasing patient panel sizes for residents and redesigning the appointment scheduling process by office staff (e.g., using an algorithm to follow depending on appointment needed). New residents will need training in self-scheduling, and new ½ sheets will need to be created as residents turnover to maintain these improvements.