Successful applicants to the ASGE Endoscopy Unit Recognition Program submit a summary of a recently conducted quality improvement (QI) project as part of the application process. The QI project in the spotlight this month looked at filling open patient slots.
DEFINE
[Our endoscopy center] experienced staffing shortages and transitioning of Scheduling management and Recall Coordinator management beginning in March of 2022. This created backlogs with scheduling in general, but specifically with filling last-minute cancellations (within one week).
MEASURE
We collected the easily accessible data by looking into the [practice management system] scheduling module. We counted how many patient slots were left open in the past 6 months (June 2022-November 2022). The open patient slots were separated into AM and PM cancellations.
| Month | AM SLOTS OPEN | PM SLOTS OPEN | TOTAL |
|---|
| June 2022 | 22 | 18 | 40 |
| July 2022 | 17 | 22 | 39 |
| Aug 2022 | 26 | 29 | 55 |
| Sept 2022 | 29 | 27 | 56 |
| Oct 2022 | 26 | 12 | 38 |
| Nov 2022 | 21 | 23 | 54 |
| Average: | 24 | 22 | 47 |
ANALYZE
We determined that there was definite room for improvement and developed a plan to focus on the cancellation slots and cancellation list. We developed a cancellation list, asking patients who wished to be scheduled earlier than currently available if they would like to be placed on the list. We then sent those patients to anesthesia right away to be cleared. We also sent their packet with the prep instructions right away and instructed the patients to fill the prescriptions for the bowel prep immediately. This would allow them to be completely ready if a cancellation slot became available, even if it was at the last minute. There would be no barriers on the [endoscopy center] side for these patients to fill the open slots. We also triaged incoming diagnostic patients and called those patients with urgent needs to perform health histories and clear them with anesthesia to get them on the cancellation list. Once all new staff were appropriately precepted, competent, and working independently, we began to roll out the plan by using the cancellation list and having one staff member dedicated to checking for cancellations daily and utilizing the list to see if any patient was able to fill the open slot. This dedicated person was also notified by the front desk staff when a cancellation happened within two days of the appointment.
IMPROVE
Data was collected for six months after initiation of the plan.
| Month | AM SLOTS OPEN | PM SLOTS OPEN | TOTAL |
|---|
| Dec 2022 | 14 | 18 | 32 |
| Jan 2023 | 24 | 6 | 30 |
| Feb 2023 | 4 | 12 | 16 |
| Mar 2023 | 10 | 10 | 20 |
| Apr 2023 | 15 | 9 | 24 |
| May 2023 | 24 | 8 | 32 |
| Average | 15 | 11 | 27 |
It was determined that the interventions improved the patient slots left open from cancellations by an average of 20 per month. We continue to use the plan to keep open slots filled.
CONTROL SUMMARY
The project outcome determined that we were able to improve patient satisfaction as well by offering patients a sooner appointment, if desired. It was found that many patients, even though they originally wished to be on the cancellation list, later decided to keep their original appointment once called to move up. We documented in the patient record that an earlier appointment was offered and declined. We also found that when the patients were given to a CRNA right away to determine if they were able to be scheduled at the [endoscopy center], some were found to need an anesthesia consult or scheduled at the hospital. This allowed them to be sent over sooner and be called by the hospital for scheduling.
Barriers encountered were:
- Even though patients initially wanted to be placed on the cancellation list to move to an earlier appointment, when we called and offered one to them, they declined and kept the original date.
- Patients had difficulty arranging drivers for dates within one or two days of the appointment date.
- Many patients are advised to do extended prepping which excludes them from moving into last minute cancellation slots.
Benefits encountered were:
- Patients with urgent needs were able to be offered earlier dates.
- Schedules were full and fewer open slots were identified.
- Patient frustrations were lessened knowing they would be placed on a cancellation list and they would have a chance to obtain an earlier appointment.
The project goal of fewer open patient slots in the schedule was achieved. Findings communicated to: Quality Assurance Committee Members Governing Board Members
We hope sharing this project summary will be useful to you and your practice. Learn more about gaining honoree status in the
ASGE Endoscopy Unit Recognition Program. EURP honoree units may use the ASGE Quality Star logo in promotion of their units, receive premium educational content via an exclusive e-newsletter
The Huddle, and enjoy a range of additional benefits. Questions should be directed to
eurp@asge.org.