missing labs
DESCRIPTION
Na=?. K=?. Missing Labs. FOBT=?. INR=?. TSH=?. AST=?. LDL=?. B12=?. Hgb=?. A1C =?. Performance Improvement Project 2013 Victor Chiu, Tamara Dahhan, Anishka D’Souza, Lara Hamadani, Eugene Kim, Brandon Murti, Isabela Wieczorek, Jessica Gomez. Goals:. - PowerPoint PPT PresentationTRANSCRIPT
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Missing LabsMissing LabsPerformance Improvement Project 2013
Victor Chiu, Tamara Dahhan, Anishka D’Souza, Lara Hamadani, Eugene Kim, Brandon Murti,
Isabela Wieczorek, Jessica Gomez
K=?Na=?
TSH=?
LDL=?AST=?
INR=?
B12=? Hgb=?
FOBT=?
A1C =?
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Goals:Goals:• Identifying patient barriers to a smooth clinic visit
o Decreasing no-showso Decreasing patient visits without labs
• Improving patient’s clinic experience
• Improving hospital and medical costs by best utilizing our resources
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How Many Patients How Many Patients Get Labs?Get Labs?
Chart Review 1/2013:
Of 95 patients in Clinic A, Endocrinology, 21% came to appointment without labs
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Process of Getting Process of Getting LabsLabs
• When the doctor orders labs, the following happens:
1) Clerk enters labs in computer2) There is an expiration that is entered. Usually
the expiration date is 2 months after their next appointment
3) Clerk prints out a copy of the labs with expiration date
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4) On check out, patient receives a copy of the lab order, a slip reminding them of their labs, and a verbal reminder to get labs before next appointment
Process of Getting Process of Getting LabsLabs
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Process of Getting Process of Getting LabsLabs
If not given an appointment in the office, the patient receives appointment in the mail (sometimes 1-2 days before appointment)
Nurses in clinic A call patients 1 day before appointment as a reminder. Labs are NOT mentioned during this call because nurses do not know if the physician ordered labs for that patient or not.
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Surveyed 65 patients in Clinic A in 2/2013
o 29% forgot to get labs • I forgot: 46%• Forgot to fast: 46%• Appointment changed/rescheduled: 38%
o What would help you get labs drawn?• Phone call: 37%• Mail 1 week before: 45%• Printed reminder after appointment: 30.7%• Email: 6%
o Wait time:• <30min: 31%• 30min-1hr: 40%• 1-2hr: 8%• >2hr: 8%
Why No Labs?Why No Labs?
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Pilot Study for Automated
Reminders
o In 2010/2011 Kaiser helped provided a grant to ValleyCare Consortium to support a pilot study enlisting 4PatientCare to help lower the no-show rate at select specialty clinics at OV-UCLA Medical Center and Mid-Valley Comprehensive Health Center.
o The initial cohort included Cardiology, Dermatology, ENT, Neurology, and Gastroenterology. The intervention included automated voice and text message appointment reminders.
o The results from the pilot demonstrated dramatic improvement in show rates in three of the five clinics analyzed
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• Average # of Specialty Appts/mo at OV: 1664• Average # of Primary Care Appts/mo at OV: 1500
• Cost of 4PatientCare reminder service:o Per month for specialty service: $350o Per month for primary care service: $315o Total: $665/month
• % of appts that are revenue producing: 30% subs; 70% PC
• Avg revenue per appt: $115 subs; $95 PC• Absolute reduction in no show rate: 6% subs; 5% PC
• Total Revenue Improvement: $5902
• Total Return on Investment: o Specialty 690%/Primary Care 1108%o Total: 888%
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The Project/IdeasThe Project/Ideas• Housestaff education
• Benefit of Fasting labs• Lab work process
• Patient education (posters, provider)o Importance of lab drawso No lab slip neededo No fasting needed unless requested
• Automated patient reminder systemo Appointment/lab/medication list reminders
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Thanks!Thanks!
• A special thanks to Drs. Rotblatt, Wasson, Richman, and Tennant