Missing LabsMissing LabsPerformance Improvement Project 2013

Victor Chiu, Tamara Dahhan, Anishka D’Souza, Lara Hamadani, Eugene Kim, Brandon Murti,

Isabela Wieczorek, Jessica Gomez

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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

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

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

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

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.

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?

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

• 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%

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

Thanks!Thanks!

• A special thanks to Drs. Rotblatt, Wasson, Richman, and Tennant