access to care

Access to CareAccess to CareAccess to CareAccess to CareBeaufort Pediatrics - Beaufort, SCBeaufort Pediatrics - Beaufort, SCBeaufort Pediatrics - Beaufort, SCBeaufort Pediatrics - Beaufort, SC

Who Is Beaufort Pediatrics?Who Is Beaufort Pediatrics?Who Is Beaufort Pediatrics?Who Is Beaufort Pediatrics?

Single specialty group practice with 4 full time physicians, 1 full Single specialty group practice with 4 full time physicians, 1 full

time nurse practitioner, 2 half time physicians, and Francistime nurse practitioner, 2 half time physicians, and Francis

Office hours 7:30 AM - 7:00 PM, Saturday 9:00 AM - 1:00 PM, Office hours 7:30 AM - 7:00 PM, Saturday 9:00 AM - 1:00 PM,

with general and well child areas.with general and well child areas.

Staggered schedule: 1st physician starts at 7:30, 2nd at 8:30, Staggered schedule: 1st physician starts at 7:30, 2nd at 8:30,

remainder start at 9:00 except for the on call physician who remainder start at 9:00 except for the on call physician who

starts at 10:00. Part time physicians with variable start times. starts at 10:00. Part time physicians with variable start times.

Post call physician does not work. Post call physician does not work.

Each full day has 32 appointment slots with various rules for Each full day has 32 appointment slots with various rules for

the number of slots allotted to specific types of appointmentsthe number of slots allotted to specific types of appointments

Access - How do we measure it?Access - How do we measure it?Access - How do we measure it?Access - How do we measure it?

1) Track the number of available appointments at the beginning 1) Track the number of available appointments at the beginning

of each day and every 2 hours thereafterof each day and every 2 hours thereafter

2) Note the number of practitioners available each day2) Note the number of practitioners available each day

3) Note if the providers were asked to extend, when they were 3) Note if the providers were asked to extend, when they were

asked to extend and how many extra appointments were asked to extend and how many extra appointments were

added.added.

4) Track these numbers for two weeks and then analyze the 4) Track these numbers for two weeks and then analyze the

data.data.

DataDataDataData

DataDataDataData

Available appointments at the start of the day ranged from 10-Available appointments at the start of the day ranged from 10-

44 with a mean of 2944 with a mean of 29

50% of the days the practitioners were asked to extend their 50% of the days the practitioners were asked to extend their

schedule with the receptionists needing appointments by 9:30 schedule with the receptionists needing appointments by 9:30

AMAM

Tuesdays and Fridays seem to be the most likely days needing Tuesdays and Fridays seem to be the most likely days needing

appointmentsappointments

Implement ChangeImplement ChangeImplement ChangeImplement Change

50% extension rate is too much50% extension rate is too much

Plan: We will implement blocked same day appointments. Each Plan: We will implement blocked same day appointments. Each

practitioner will have 2 appts. blocked in each half day of their practitioner will have 2 appts. blocked in each half day of their

schedule unless they are in the well child clinicschedule unless they are in the well child clinic

This should guarantee 16-24 appointments at the beginning of This should guarantee 16-24 appointments at the beginning of

each dayeach day

DataDataDataData

DataDataDataData

Available appointments ranged from 16-54 at the start of the Available appointments ranged from 16-54 at the start of the

day with a mean of 32 (10% increase)day with a mean of 32 (10% increase)

30% of the days the practitioners were asked to extend with the 30% of the days the practitioners were asked to extend with the

receptionists needing appointments by 11:30receptionists needing appointments by 11:30

Monday and Tuesday are the more difficult daysMonday and Tuesday are the more difficult days


40% reduction in extended days - we’re pretty happy40% reduction in extended days - we’re pretty happy

We will continue with the present number of blocked We will continue with the present number of blocked

appointments anticipating we will need to increase the number appointments anticipating we will need to increase the number

as the level of illness increases with the onset of cold and flu as the level of illness increases with the onset of cold and flu

seasonseason

DataDataDataData

DataDataDataData


day with a mean of 38 (15% increase)day with a mean of 38 (15% increase)



Tuesday and Friday prove to be needy days againTuesday and Friday prove to be needy days again


Still feeling pretty good, the numbers are staying about the Still feeling pretty good, the numbers are staying about the

same if not a little bettersame if not a little better

We will continue with the present number of blocked We will continue with the present number of blocked

appointments as we have yet to see a significant increase in appointments as we have yet to see a significant increase in

illness in the community.illness in the community.

DataDataDataData

DataDataDataData

Available appointments ranged from 7-78 at the start of the day Available appointments ranged from 7-78 at the start of the day

with a mean of 25 (32% decrease!)with a mean of 25 (32% decrease!)


receptionists needing appointments by 8:30 - 10:00receptionists needing appointments by 8:30 - 10:00

It didn’t matter what day this period!It didn’t matter what day this period!

QuickTime™ and aH.264 decompressor

are needed to see this picture.


We did not anticipate well for Dr. KM’s maternity leave and were We did not anticipate well for Dr. KM’s maternity leave and were

very understaffed. However, by the end of the period were very understaffed. However, by the end of the period were

were recovering.were recovering.

We decided to leave the number of blocked appointments the We decided to leave the number of blocked appointments the

same as we were anticipating more Francis sightings over the same as we were anticipating more Francis sightings over the

upcoming weeks, and Dr. BM will be back from his time off with upcoming weeks, and Dr. BM will be back from his time off with

the baby.the baby.

DataDataDataData

DataDataDataData


day with a mean of 23 (4% decrease)day with a mean of 23 (4% decrease)



Tuesday once again is a consistent day needing appointmentsTuesday once again is a consistent day needing appointments


Despite being understaffed, the numbers look better. The week Despite being understaffed, the numbers look better. The week

of Thanksgiving was omitted due to the altered schedule during of Thanksgiving was omitted due to the altered schedule during

that week.that week.

We were beginning to see an increase in respiratory illness We were beginning to see an increase in respiratory illness

around the community and we are understaffed, so we decided around the community and we are understaffed, so we decided

to increase the number of blocked appointments to 5 per to increase the number of blocked appointments to 5 per

provider for the next cycle.provider for the next cycle.

DataDataDataData

DataDataDataData


day with a mean of 44 (91% increase!)day with a mean of 44 (91% increase!)

0% of the days the practitioners were asked to extend0% of the days the practitioners were asked to extend


We overshot this cycle with the increased number of blocks and We overshot this cycle with the increased number of blocks and

an increased number of Francis sightings around the office.an increased number of Francis sightings around the office.

Despite this, given the time of year, we did not reduce the Despite this, given the time of year, we did not reduce the

number of blocks in anticipation of cold and flu outbreaks. number of blocks in anticipation of cold and flu outbreaks.

DataDataDataData

DataDataDataData

Available appointments ranged from 9-64 at the start of the day Available appointments ranged from 9-64 at the start of the day

with a mean of 30 (31% decrease)with a mean of 30 (31% decrease)

56% of the days the practitioners were asked to extend by 56% of the days the practitioners were asked to extend by

anywhere from 9:30 - 12:00.anywhere from 9:30 - 12:00.

Tues. and Wed. were the needy days.Tues. and Wed. were the needy days.


We made the right choice of keeping the 5 blocks in place. We made the right choice of keeping the 5 blocks in place.

Despite this, we still needed to extend over half the days.Despite this, we still needed to extend over half the days.

Bronchiolitis is on the rise as well as gastroenteritis. No flu yet Bronchiolitis is on the rise as well as gastroenteritis. No flu yet

but should be soon. We will increase to 6 blocked appointments but should be soon. We will increase to 6 blocked appointments

per provider. per provider.

DataDataDataData

DataDataDataData


day with a mean of 29 (3% decrease)day with a mean of 29 (3% decrease)

22% of the days the practitioners were asked to extend by 22% of the days the practitioners were asked to extend by

anywhere from 10:30 - 12:00anywhere from 10:30 - 12:00

Tuesday remains the most consistent day we need Tuesday remains the most consistent day we need

appointments.appointments.


The increase in blocked appointments was successful again. We The increase in blocked appointments was successful again. We

had fewer extended days despite the mean staying the same.had fewer extended days despite the mean staying the same.

No planned change for the next cycle No planned change for the next cycle

What did we learn?What did we learn?What did we learn?What did we learn?

We were able to positively impact our ability to accommodate We were able to positively impact our ability to accommodate

access for our patients through a stepwise increase in the access for our patients through a stepwise increase in the

number of dedicated same day appointments based on the number of dedicated same day appointments based on the

level of illness in the community. level of illness in the community.

We were able to reduce the number of days our providers We were able to reduce the number of days our providers

needed to extend their schedules to meet appointment needs. needed to extend their schedules to meet appointment needs.

Although appointment demand is difficult to predict.Although appointment demand is difficult to predict.

Patients had more opportunity to see “their doctor” for same Patients had more opportunity to see “their doctor” for same

day appointments. day appointments.

What did we learn?What did we learn?What did we learn?What did we learn?

Tuesday is our most consistently demanding day for Tuesday is our most consistently demanding day for

appointments. Is it easier for parents to miss work on Tuesday appointments. Is it easier for parents to miss work on Tuesday

than it is on Monday?than it is on Monday?

If we have less than 5 providers on a particular day, we likely If we have less than 5 providers on a particular day, we likely

won’t have enough appointments.won’t have enough appointments.

Hopefully, this work will allow us to meet the standards for this Hopefully, this work will allow us to meet the standards for this

section of the NCAQH section of the NCAQH