Butz Catherine, Castillo Anthony, Gallup James, Valleru Jahnavi, Butter Eric
Pediatric Psychology, Nationwide Children's Hospital, Columbus, Ohio.
Department of Pediatrics, The Ohio State University, Columbus, Ohio.
Pediatr Qual Saf. 2019 Dec 6;4(6):e240. doi: 10.1097/pq9.0000000000000240. eCollection 2019 Nov-Dec.
Efficient access to pediatric mental health services is a growing concern as the number of patients increases and outpaces efforts to expand services. This study outlines interventions implemented using quality improvement (QI) science and methodology to demonstrate how a clinic embedded in a large children's hospital can improve access to the first appointment for a population seeking pain management services.
A process improvement project started with a QI team, whose members designed interventions to change scheduling practices. Initial changes involved decreased time between calls to families, and efforts to streamline notifications among clinicians. Additional interventions included a close examination of waitlist assignment based on appropriateness and assessing patient interest in treatment.
Within 3 months of implementation, a significant decline in wait time occurred for patients seeking services for pain management, from 106 to 48 days. This change remained stable for 6 months. In light of a sharp increase in referrals and wait time during the study period, efforts to engage additional clinicians in managing referrals resulted in wait time to stabilize at an average of 63 days to the first appointment. This change remained for 10 months. Scheduling changes did not negatively affect other providers.
This study demonstrates the application of QI science to improve patient access to mental health care. Future directions will focus on enhancing the use of the electronic health record, along with previsit family engagement.
随着患者数量的增加且超过了扩大服务的努力，高效获得儿科心理健康服务日益受到关注。本研究概述了使用质量改进（QI）科学和方法实施的干预措施，以展示一家大型儿童医院内的诊所如何改善寻求疼痛管理服务人群的首次预约机会。
一个过程改进项目始于一个QI团队，其成员设计干预措施以改变排班做法。最初的改变包括减少给家庭打电话的间隔时间，以及努力简化临床医生之间的通知。额外的干预措施包括根据适宜性仔细审查候补名单分配情况，并评估患者对治疗的兴趣。
在实施后的3个月内，寻求疼痛管理服务的患者等待时间显著下降，从106天降至48天。这一变化在6个月内保持稳定。鉴于研究期间转诊和等待时间急剧增加，让更多临床医生参与管理转诊的努力使等待时间稳定在首次预约平均63天。这一变化持续了10个月。排班变化未对其他提供者产生负面影响。
本研究展示了QI科学在改善患者获得心理健康护理方面的应用。未来的方向将集中在加强电子健康记录的使用以及就诊前的家庭参与。
