Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE 19803, USA.
Pediatrics. 2013 May;131(5):e1632-8. doi: 10.1542/peds.2012-2372. Epub 2013 Apr 1.
To describe the implementation and evaluation of a quality improvement intervention to increase new-patient access and decrease time-to-appointment wait for gastroenterology care.
We used a new model of care for gastroenterology evaluation. For specified clinical complaints, we offered new-patient appointments that were scheduled with a general pediatrician as an alternative to a subspecialist. A nurse navigator assisted in triaging patients. We analyzed all patient encounters over an 8-month period. To verify decreased time-to-appointment wait, mystery shoppers made semimonthly calls to centralized scheduling. We surveyed parents/families after visits with the pediatrician or subspecialists regarding satisfaction.
The "access" pediatrician evaluated and treated ∼40% of all new patients presenting to the division during the study period. Approximately 10% of new patients evaluated by the pediatrician (4% overall) were referred on to the subspecialist; fewer patients were reevaluated by the pediatrician in follow-up. The pediatrician ordered a minimal number of procedures. Semimonthly sampling revealed that overall new-patient access improved from an average time-to-appointment wait of 25 days to <1 day. Parent/family satisfaction was high for the patients evaluated by the pediatrician.
Embedding a general pediatrician within a subspecialty division, and navigating patients to this provider, can increase access to treatment of new low- to moderate-complexity patients. The access pediatrician can maintain patient satisfaction, provide high-quality care, and decrease need for subspecialist evaluation. The model, in the setting of a large academic medical center, may provide a solution for barriers to patient care such as lengthy time-to-appointment wait.
描述一项质量改进干预措施的实施和评估，以增加新患者就诊机会并缩短胃肠病学治疗的预约等待时间。
我们使用了一种新的胃肠病学评估护理模式。对于特定的临床症状，我们提供新患者预约服务，由普通儿科医生而不是专科医生进行预约。护士导航员协助分诊患者。我们在 8 个月的时间内分析了所有患者的就诊情况。为了验证预约等待时间的缩短，神秘顾客每月两次致电集中预约处进行调查。我们在儿科医生或专家就诊后对家长/家属进行调查，了解他们的满意度。
在研究期间，“就诊”儿科医生评估和治疗了大约 40%的所有新患者。由儿科医生评估的新患者中，约有 10%（总体为 4%）被转介给专科医生；在后续随访中，较少患者需要再次由儿科医生评估。儿科医生只开了少量的检查。每月两次的抽样调查显示，新患者的整体就诊机会得到了改善，预约等待时间从平均 25 天缩短至不到 1 天。接受儿科医生评估的患者家长/家属满意度很高。
在专科分部中嵌入一名普通儿科医生，并引导患者到该医生处就诊，可以增加新的低至中度复杂程度患者的治疗机会。就诊儿科医生可以维持患者满意度，提供高质量的护理，并减少专科医生评估的需求。在大型学术医疗中心的环境下，该模式可能为患者护理方面的障碍（如预约等待时间长）提供解决方案。
