Open-access Scheduling Speeds Pediatric Subspecialty Visits

Troy Brown

January 21, 2013

The average waiting time for new pediatric endocrinology appointments dropped from 11.4 to 1.7 weeks after implementation of open-access scheduling at an urban academic hospital faculty-based practice.

Rubina A. Heptulla, MD, professor of pediatrics and medicine and division chief of Pediatric Endocrinology and Diabetes at Albert Einstein College of Medicine in Bronx, New York, and colleagues published their findings online January 21 in Pediatrics.

"The pediatric specialty workforce currently is unable to keep up with the demand for timely access to health care," the authors write. They note that inadequate access to pediatric subspecialty care can result in delayed diagnosis and treatment.

The open-access model, in which physicians adjust their availability to meet individual practice demands, has been used successfully in the primary care setting but has not been tested in pediatric specialty clinics.

Starting in October 2010, the pediatric endocrine division in the Children’s Hospital at Montefiore in the North Bronx in New York City implemented 3 scheduling changes:

  1. New patient appointments were no longer allowed to be converted to follow-up appointments.

  2. All physicians, even senior faculty, were required to see 3 to 4 new patients each session.

  3. Extra sessions (staffed by a nurse practitioner or physician assistant) devoted only to follow-up appointments were added as needed.

The researchers analyzed data from January 2008 to November 2011.

Wait Times Plummet

After the initiation of the open-access model, the mean wait time for a new appointment dropped dramatically from 11.0 weeks (95% confidence interval [CI], 7.7 - 15.0 weeks) to 1.7 weeks (95% CI< 0 - 5.3 weeks; P < .001), even though new patient volume increased from 27% of the total visit volume before open-access scheduling to 35% after open-access scheduling was instituted.

The mean monthly total visit volume rose from 284 before the intervention to 374 patients after it (P < .01), indicating that improved access resulted from the intervention and not from a decreased demand for appointments.

The wait time for follow-up appointments also fell from 8.2 weeks (95% CI, 5.7 - 11.0 weeks) to 2.9 weeks (95% CI, 0 - 4.6 weeks) postintervention (P < .001).

When total monthly visit volume per provider during the preceding year was compared with that of the year after the intervention, the mean monthly visit volume rose from 38.5 patients (95% CI, 30.1 - 44.6 patients) to 41.60 patients (95% CI, 33.7 - 52.3 patients) per provider (P > .05).

The no-show rate fell from 29% to 26% postintervention, but this was not significant (P = .29).

"[W]e markedly improved a long-standing access problem for a pediatric subspecialty practice by using the principles of advanced access scheduling," the authors write.

The authors have disclosed no relevant financial relationships.

Pediatrics. Published online January 21, 2013.

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