Does a Centralized Scheduling Process Improve Referral Timeliness?

BACKGROUND: Timely, necessary specialist care is associated with better patient health outcomes and lower costs. This assessment looks at the effects of centralized scheduling, as well as patient and referral-level factors on referral completion rates. We hypothesized that centralized scheduling would increase access to specialty care, as evidenced by higher referral completion rates. METHODS: We analyzed data for specialty referrals to cardiology, nephrology, gastroenterology, and neurology from 6 months before to 6 months after implementation of a centralized scheduling system within a midwestern academic health system. We considered a referral complete if an appointment occurred within 3 months following an order for service. RESULTS: Overall, referral completion rates modestly increased (63.7% to 69.9%, P < 0.01), but this was driven by improvement within a single specialty (gastroenterology, 54.2% to 67.3%, P < 0.05). Other specialties saw either no significant change (neurology, nephrology) or a decrease (cardiology, 87.3% to 78.6%, P < 0.05). The time to schedule, or cycle time, improved overall from 21 days (SD 8-38) to 15 days (SD 8-30), P <0.05. CONCLUSIONS: Centralized scheduling had inconsistent effects on referral completion across specialties, though the process (cycle time) improved. Variable implementation fidelity and microenvironments likely contributed to uneven findings across specialties. Centralized scheduling may improve timely access but likely depends on implementation and buy-in.

No relationship between measures of clinical efficiency and teaching effectiveness for emergency medicine faculty.

OBJECTIVES: Emergency medicine (EM) doctors affiliated with academic institutions experience professional tension between providing excellent, timely care for patients and high-quality bedside instruction for residents and medical students. The goal of this study was to assess the relationship between measures of faculty clinical efficiency and teaching effectiveness. METHODS: This was a retrospective review of data from a single academic institution with an annual census of 55,000. Faculty clinical efficiency was measured by two variables: the relative value unit (RVU)/h ratio and average 'door to discharge' time. Teaching effectiveness was estimated by determining the average 'overall teaching' scores derived from anonymous EM resident and senior medical student evaluations. Relationships were assessed using the Spearman's correlation coefficient. RESULTS: There was no statistically significant relationship (p>0.050) between measures of faculty clinical efficiency and teaching effectiveness. CONCLUSION: These data replicate previous findings that clinical productivity has no correlation with teaching effectiveness for emergency medicine faculty doctors.

The effects of a physician-nurse patient care team on patient satisfaction in an academic ED.

The objectives were to investigate the effects of a RN/MD patient care team operational change on ED patient satisfaction. In period 1, RNs had standard room assignments and MDs evaluated patients based upon physician availability and perceived patient load. In period 2, RNs and MDs were organized into 2 patient care "teams" and patients were assigned to teams on an alternating basis. Patient satisfaction was rated using the standard ED Press, Ganey survey instrument. A total of 508 surveys were returned in period 1 and 454 in period 2. From period 1 to 2, overall ED patient satisfaction improved from 78.2 +/- 20.4% to 82.2 +/- 17.2% (improvement from 23rd to 59th percentile, P

Mission-based budgeting hours model: an accurate way to understand physician costs.

Financial resources to manage academic emergency departments are becoming more scarce. The Association of American Medical Colleges (AAMC) has embraced mission-based management (MBM) as one viable option to allocate financial and personnel resources based on medical school goals. The key features of this style are integrating financial statements, measuring faculty activity, holding service line leaders accountable, and building a trust through information sharing. The authors describe how they integrated their service line cost through an hours model. From this they describe a formula for calculating the cost of protected time. The authors use mission-based budgeting to more accurately understand their physician costs and use the formula to effectively negotiate internal and external contracts.