WIP 02 - “That’s my patient!”: A Quality Improvement project to Improve Resident Continuity in an Outpatient Pediatric Clinic

Publication Number: WIP 02.7572

Austin M. Yoders, The Mount Sinai Kravis Children's Hospital, New York, NY, United States; Cindy Jiang, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Stephanie S.. Raps, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Young Jin Kim, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Kelly Lau, Mount Sinai Hospital, New York City, NY, United States; Olivia Zhong, Icahn School of Medicine at Mount Sinai, Brooklyn, NY, United States; Andria Sharma, The Mount Sinai Kravis Children's Hospital, NEW YORK, NY, United States; Daniel R. Schecter, The Mount Sinai Kravis Children's Hospital, New York, NY, United States; Zackary Brown, The Mount Sinai Kravis Children's Hospital, New York, NY, United States; Cynthia M. Katz, General Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Background: Primary care experiences are integral to pediatric residency training, and continuity between patients and resident providers is beneficial. For resident trainees, continuity improves their educational experience, promotes efficiency, fosters stronger patient-provider relationships, and decreases frustration and burnout. For patients and families, greater continuity leads to greater satisfaction, lower emergency room utilization, decreased hospitalizations, and increased adherence to appointments and immunizations. As in many residency programs, maintaining continuity has also been a challenge in our program.

Objective: The aim of this Quality Improvement project is to increase the proportion of patients known to the scheduled provider, per clinic session, from 25 to 50%.

Design/Methods: Project planning included mapping several key processes impacting our outcome: front desk scheduling algorithm and PCP assignments in the EMR. Our outcome measure is defined as the proportion of patients seen for well child or follow up visits that the provider has seen at least once before. Process measures include: PCP assignments in EMR, scheduling appointments at time of discharge from the clinic, and utilization of provider-held slots. Balancing measures include the number of “no shows”, residents overbooking schedules, and waiting time at the front desk. A Fishbone Diagram identified potential reasons for failure, and a Key Driver Diagram highlighted drivers for success and helped to brainstorm change ideas.

Baseline Data collection via manual chart review shows the rate of resident continuity at 25%. Planned interventions include: implementation of blocked private slots for resident-only booking, establishing a standardized PCP-assignment algorithm, and utilization of appointment cards to assist with future appointments. Iterative PDSA cycles will consist of implementation of new workflows and dissemination through education. Data will be displayed on run charts to assess changes over time for each of our defined measures.