Providing easy, efficient access to care is more than scheduling an appointment. It’s about scheduling the right appointment. And finding the right appointment can be driven by multiple factors.
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“When an orthopaedic consult is needed, providers are looking to connect their patient with the right provider, at the right location, on the right day, at the right time and to have the right images ordered before the appointment,” says Dominic King, DO, Director of Clinical Transformation for Cleveland Clinic’s Orthopaedic and Rheumatologic Institute.
Every month, there are more than 9,000 orthopaedic consults placed at Cleveland Clinic. This heavy patient volume, coupled with operational complexity, can complicate access.
“Think of using OpenTable to make an online restaurant reservation,” describes Dr. King. “It’s such an easy, efficient experience — that’s the same experience we want for our patients. However, we lacked the technology needed to support that experience, especially given the complicated triage that is involved with providing access to patients with Orthopaedic injuries and musculoskeletal conditions.”
Focusing on this challenge meant exploring existing processes, gathering team input and using the Cleveland Clinic Improvement Model (CCIM) to develop solutions that could quickly connect patients to the right care.
To understand the patient’s journey, several teams evaluated each component of the process to determine its functionality and necessity. The tipping point came when the team realized that there were potentially 500 decision tree pathways involved in scheduling a consult.
Dr. King explains, “We partnered with stakeholders from across the enterprise to break down each element so we could figure out how to transform our current state and create the ideal patient access journey. Using the CCIM, we learned to look beyond a quick fix. It’s the small, iterative steps that yield sustainable outcomes.”
The team leaned on technology to streamline quick access to the right appointment. The solution: a standardized triage logic algorithm based on condition-specific discrete data elements to automate a consistent, efficient and highly reliable scheduling platform.
Dr. King adds, “We made significant progress by reducing the decision support triage elements to two core areas: primary joint of concern and primary condition. From there, Brendan M. Patterson, MD, our chair of the Department of Orthopaedic Surgery, along with department center and section directors, validated the patient workflows and developed the standardized triage logic. With the full participation of our ORI-Access Governance Team, there was unified agreement to move forward.”
Now, with order-based scheduling (OBS) enabled, a few clicks can generate a consult to Orthopaedics which results in 1) an appointment scheduling by the ordering provider during the office visit, 2) self-scheduling by the patient through the electronic health portal or 3) a patient-initiated phone call to the Access Center for expedited scheduling according to the standardize triage logic.
Even with online tools, some patients still prefer one-on-one scheduling over the phone.
Incorporating the standardized triage logic into the Access Center intake process involved several conversations with clinical and scheduling teams. As a first step, schedulers can check for OBS status. When OBS is completed, the scheduler bypasses the decision tree questions to select the right appointment for the patient.
Within a few months of launching OBS, the scheduling time on the phone has decreased by nearly 40%. With less time on these types of calls, caregivers can focus their attention on patients requiring more assistance.
For Dawn Colwell, Access Transformation Senior Director, the early results are encouraging.
“There’s a lot of promise and potential to further OBS integration,” says Colwell. “But equally exciting to the tool’s effectiveness and efficiency is the shared participation, collaboration and governance that lead to this early success. We will continue working together to look for expansion opportunities.”