City of Hope patients now are able to get consultation appointments faster and more conveniently and have their surgery scheduled more efficiently thanks to the Accelerating Care Excellence (ACE) program.
Two teams of management and staff recently met as part of ACE to tackle care coordination and integration at the medical center. One rapid improvement team focused on the topic of managing medical consults among City of Hope physicians, and a second addressed streamlining surgery scheduling. They reported their achievements to the City of Hope community on April 9.
 Brenda Martinez, left, and Jennifer Davis discuss operating room scheduling during a report out skit as faux patient Ben Calnon awaits surgery. (Photo by p.cunningham) |
Consulting another physician
Treating cancer requires bringing together physicians from different disciplines — and physicians often request consults from City of Hope colleagues with unique expertise. That can take time.
“We found that patients experienced long waits from the time their physician requested a consult from a colleague to the appointment day with the second physician,” said Sandra Bolton, R.N., J.D., vice president of professional services and executive sponsor for the consultation team. “Major contributing factors included the use of hand-carried photocopies or faxed consult requests.”
Due to a lack of coordination, many consultation appointments required rescheduling, according to the team’s research.
The team implemented several solutions. Now most consult requests are scheduled before patients leave the clinic and patients receive an appointment confirmation containing a brief description of the service they will receive.
By the end of the improvement event, many patients with scheduled appointments expressed their gratitude to clinic staff for the more thorough information they received about their upcoming consultation.
Scheduling surgery
Scheduling a patient for surgery requires staff members to order materials and equipment, schedule key health-care professionals and book operating rooms.
“On average, City of Hope schedules 25 to 30 procedures each day, and making efficient use of our operating rooms is critical to providing the best patient care we can,” said Shirley Johnson, R.N., M.S., chief nursing and patient services officer.
The process sometimes resulted in surgery holdups, and the scheduling team identified several contributing factors. For one, surgeons, anesthesiologists, nurses and others involved in procedures used several independent calendars without a standard method of pushing updates to all groups.
They also found that the use of existing scheduling forms resulted in inefficient operating room scheduling, which sometimes caused delays. Johnson, who served as the team’s executive sponsor, said that electronic forms are being developed to more accurately capture the exact time and equipment needs of a procedure. Current order forms are now scanned so they are immediately available and operating room schedulers were provided a dedicated office to enable more efficient scheduling.
The next two ACE events are scheduled for May 3 to 7. They will address patient referrals from outside physicians and organizing dedicated care teams for surgery patients.
For more information, employees may visit www.coh.org/ACE. Questions about ACE also may be addressed to Tricia Kassab, R.N., B.S.N., M.S., vice president of quality and patient safety, at tkassab@coh.org.
Sustained improvements
The ACE program has conducted 11 rapid improvement events since November 2009. Teams focus exclusively on one area for a week to implement improvements immediately, but they also ensure that improvements continue.
“The saying goes that it takes a village to raise a child. Well, it takes a village to improve patient care, and our staff is that village,” said Alexandra Levine, M.D., M.A.C.P., chief medical officer. “It is hard work, but each month our teams tackle another issue, and each month they are bringing us closer to the true excellence our institution has always represented.”
Achievements continue: It now takes only 30 minutes for new patients to get an appointment scheduled with a surgeon during their first call. Before the improvement event, patients typically waited several days. In the past month, surgeons saw more than 300 new patients, up 22 percent since the rapid improvement event in January. Overall, City of Hope saw more than 650 new patients, an increase of 31 percent. Instead of asking new patients to collect all of their own medical records in advance of their initial clinic appointment, City of Hope staff collected the records on behalf of new patients more than 86 percent of the time in April, compared to an initial rate of 18 percent prior to the improvement event.
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