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The appointments were analyzed the same way to determine success of the interventions.RESULTS: Using the findings from the process maps the team was able to determine wait times and rework as areas for quality improvement. Rework is defined as the technician or provider having to see the patient multiple, separate times during a clinic visit. For example, a patient sees the provider, provider requests post void residual (PVR), patient leaves with technician to get PVR, patient returns to provider. This was considered provider rework. We implemented assigning one technician to one provider, prepping patient charts in advance, and daily huddles. Through these interventions the clinic was able to see significant improvements in all areas of concern. When looking at the provider clinic, the initial wait times dropped by up to 63%. Rework was decreased by 48%. The overall number of technician rework decreased by 17% and overall provider rework decreased by 50%. These decreases saved a median of 6 minutes per visit equaling 98 minutes a day saved. The procedure clinic also saw significant improvements including up to a 43% decrease in the initial wait time, the chance of all rework decreasing by 55%, and the technician rework decreased by 36%. The total length of visit from procedures decreased by 16 minutes or 30%.CONCLUSIONS: Lean methodologies, such as process mapping and PDSA cycles, are an effective way to identify areas for improvement in an outpatient urology clinic. We developed several action items including pairing one technician to one provider, prepping patient charts, and implementing daily huddles. These interventions proved beneficial in reducing waste and operating a more effective and efficient clinic.

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INTRODUCTION AND OBJECTIVE: Gross Hematuria (GH) is associated with up to 20-25% incidence of genitourinary (GU) malignancy. Given that the emergency department (ED) is often the first point of care for patients presenting with GH, we assessed the demographics of GH patients presenting to the ED and subsequently diagnosed with new genitourinary (GU) malignancy within a safety net, tertiary care health system over a one-year period.METHODS: Patients presenting with GH to six EDs within the Henry Ford Health System (Southeast Michigan) between 1/1/2019 to 12/31/2019 and subsequently newly diagnosed GU malignancy were evaluated with respect to relevant socio-demographic and tumor variables.RESULTS: Of the 286,313 ED presentations in 2019, 1370 had a diagnosis of GH (0.48%), and 19 (1.4%) were subsequently diagnosed with of GU cancer.Median (IQR) age at diagnosis was 73 (68.5-84) years, 16% were Black, 26% female, 25% had family history of GU cancer and 58% were active smokers (average 42 pack year). Median household income was $54,168, 9% less than median state income. All patients were insured.Median time to diagnosis was 33 days, which was reduced to 20 days if Urology was consulted. Bladder (53%) and prostate (26%) comprised the majority of newly diagnosed GU cancers (Figure 1).CONCLUSIONS: Somewhat contrary to our hypothesis, GH represented w0.5% of all ED visits, with a small proportion (1.4%) being diagnosed with new GU cancer. This may be related to stage migration (earlier detection of cancers with imaging), better insurance (100% of our cohort was insured) or better access to care (HFHS is a tertiary care, safety net hospital). While timely urology evaluation decreased time for diagnosis (33 to 20 days) and majority (53%) were newly diagnosed with bladder cancer, nearly half harbored advanced prostate or kidney cancer when presenting with GH. Limitations of our study include a short analytic cohort (1 year), lack of survival outcomes and single center data.