Expeditious emergency room referral pathway improves patient access to otolaryngology care

Abstract

ObjectivesHistorically at a multi‐hospital residency program, there was an unexpected number of non‐urgent consults from the county hospital emergency room (ER) that caused residents to make more trips between hospitals and come closer to violating duty hours. Moreover, there was also a poor follow‐up rate for these patients. An alternate pathway to redirect such consults to the Otorhinolaryngology–Head and Neck Surgery (ORL–HNS) clinic, staffed by an attending physician, was devised. This study illustrates how an undemanding process change can improve access to care, and resident duty hours and satisfaction.Study DesignQuality Improvement StudyMethodsThe average rate of no‐show appointments and overall number of patients referred from the county hospital ER; a survey of impact on resident workload; and an average number of on‐call resident trips to county hospital were compared in the 12 months before and after implementation of an expedited ER referral pathway.ResultsThe overall number of patients referred to clinic from ER increased by 35% (123 to 166 patients). The average number of completed visits for patients referred to the ORL‐HNS clinic from the ER increased by 29% (91 to 117 patients). There was no statistically significant change in the no‐show rate of said patients. The average number of overnight resident trips to the county hospital, frequency of resident unpreparedness for routine clinical duty and need to alter schedule to avoid duty hour violations all decreased, while resident satisfaction increased.ConclusionsAn undemanding process change in a safety‐net, publicly‐funded, county hospital setting can decrease resident workload and improve satisfaction while possibly improving patient access to specialty clinic care and follow‐up rates for patients.Level of Evidenceclinical outcomes, level IV

Interventions to increase appointment attendance in safety net health centers: A systematic review and meta‐analysis

“…Among six studies of facilitated appointment scheduling, five studies tested direct scheduling interventions to promote appointment attendance 9‐13 and one study compared attendance rates under three scheduling models: first available appointments, appointments within 2‐ and 4‐week windows 14 . Chan et al implemented an internet‐based referral system that enabled emergency department (ED) physicians to directly schedule patient follow‐up appointments with local community clinics and provide patients with printed appointment information and directions as part of their ED discharge paperwork, compared with usual care that required patients to schedule their own follow‐up appointments post‐discharge 9 .…”

“…Similarly, Messina et al facilitated patient phone calls to specialty providers from the ED in order to schedule follow‐up appointments prior to discharge 10 . Johnson et al tested a referral pathway that allowed ED nurses to schedule specialty follow‐up appointments for patients without requiring physician approval, and the specialty clinic expanded the number of follow‐up appointments available 11 . In Van Zyl et al, patients identified at a health fair as being at risk for glaucoma were offered pre‐scheduled appointments at community health centres, instead of being asked to call the health centre to schedule a follow‐up appointment 12…”

“…Patients who received interventions that facilitated scheduling were three times as likely to attend their next appointment compared to those who did not experience scheduling modifications. This approach was tested under the premise that offering same‐day access, pre‐scheduled follow‐up appointments and simpler referral pathways would reduce the burden on patients and promote appointment attendance 9‐14 . Facilitated scheduling interventions have yielded mixed results for increasing appointment attendance in non‐SNS 43 .…”

The burden of flashes and floaters in traditional general emergency services and utilization of ophthalmology on-call consultation: a cross-sectional study

“…Front-end processes are defined as the patient care processes that occur from the time of a patient’s initial arrival to a GES to the time a health care provider formally assumes responsibility, notably including the triage process[ 26 ]. Previous studies have demonstrated the efficacy of front-end operation targeted care pathways to improve the care of otolaryngologic and head and neck emergency patients[ 27 ], emergency presentations for cystitis[ 28 ], and common gynecologic emergencies[ 29 ]. In all studies, the identification of appropriate patients at triage for specifically designed care pathways resulted in a reduction in wait times and burden on health care providers without compromising safety.…”

Efficiency through a Lean Healthcare Implementation in a Public Hospital

“…The synergy of both LH and SS methodologies, that is LSS, seems to be one of the most innovative and effective approaches in "Operational Excellence" [25], and are effective quality improvement methods widely adopted by manufacturing industries that are currently also implemented in many health care settings [26]. In the field of health care, LSS has been used to address numerous health care problems [27], some of them include areas as: Trauma center [28], Cardiology [29], Surgery [30], operating room [31], Intensive care unit [32], rehabilitation ward [23], and Otolaryngology care [33].…”