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Missing Labs

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:.

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Missing Labs

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  1. 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

  2. Goals: • Identifying patient barriers to a smooth clinic visit • Decreasing no-shows • Decreasing patient visits without labs • Improving patient’s clinic experience • Improving hospital and medical costs by best utilizing our resources

  3. How Many Patients Get Labs? Chart Review 1/2013: Of 95 patients in Clinic A, Endocrinology, 21% came to appointment without labs

  4. Process of Getting Labs • When the doctor orders labs, the following happens: • Clerk enters labs in computer • There is an expiration that is entered. Usually the expiration date is 2 months after their next appointment • Clerk prints out a copy of the labs with expiration date

  5. Process of Getting Labs 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

  6. Process of Getting Labs 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.

  7. Why No Labs? Surveyed 65 patients in Clinic A in 2/2013 • 29% forgot to get labs • I forgot: 46% • Forgot to fast: 46% • Appointment changed/rescheduled: 38% • What would help you get labs drawn? • Phone call: 37% • Mail 1 week before: 45% • Printed reminder after appointment: 30.7% • Email: 6% • Wait time: • <30min: 31% • 30min-1hr: 40% • 1-2hr: 8% • >2hr: 8%

  8. Pilot Study for Automated Reminders 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. The initial cohort included Cardiology, Dermatology, ENT, Neurology, and Gastroenterology. The intervention included automated voice and text message appointment reminders. The results from the pilot demonstrated dramatic improvement in show rates in three of the five clinics analyzed

  9. Average # of Specialty Appts/mo at OV: 1664 • Average # of Primary Care Appts/mo at OV: 1500 • Cost of 4PatientCare reminder service: • Per month for specialty service: $350 • Per month for primary care service: $315 • 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: • Specialty 690%/Primary Care 1108% • Total: 888%

  10. The Project/Ideas • Housestaff education • Benefit of Fasting labs • Lab work process • Patient education (posters, provider) • Importance of lab draws • No lab slip needed • No fasting needed unless requested • Automated patient reminder system • Appointment/lab/medication list reminders

  11. Thanks! A special thanks to Drs. Rotblatt, Wasson, Richman, and Tennant

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