Access to Care

1. Access to Care • Beaufort Pediatrics - Beaufort, SC

2. Who Is Beaufort Pediatrics? • Single specialty group practice with 4 full time physicians, 1 full time nurse practitioner, 2 half time physicians, and Francis • Office hours 7:30 AM - 7:00 PM, Saturday 9:00 AM - 1:00 PM, with general and well child areas. • Staggered schedule: 1st physician starts at 7:30, 2nd at 8:30, remainder start at 9:00 except for the on call physician who starts at 10:00. Part time physicians with variable start times. Post call physician does not work. • Each full day has 32 appointment slots with various rules for the number of slots allotted to specific types of appointments

3. Who Is Beaufort Pediatrics? • Single specialty group practice with 4 full time physicians, 1 full time nurse practitioner, 2 half time physicians, and Francis • Office hours 7:30 AM - 7:00 PM, Saturday 9:00 AM - 1:00 PM, with general and well child areas. • Staggered schedule: 1st physician starts at 7:30, 2nd at 8:30, remainder start at 9:00 except for the on call physician who starts at 10:00. Part time physicians with variable start times. Post call physician does not work. • Each full day has 32 appointment slots with various rules for the number of slots allotted to specific types of appointments

4. Who Is Beaufort Pediatrics? • Single specialty group practice with 4 full time physicians, 1 full time nurse practitioner, 2 half time physicians, and Francis • Office hours 7:30 AM - 7:00 PM, Saturday 9:00 AM - 1:00 PM, with general and well child areas. • Staggered schedule: 1st physician starts at 7:30, 2nd at 8:30, remainder start at 9:00 except for the on call physician who starts at 10:00. Part time physicians with variable start times. Post call physician does not work. • Each full day has 32 appointment slots with various rules for the number of slots allotted to specific types of appointments

5. Access - How do we measure it? • 1) Track the number of available appointments at the beginning of each day and every 2 hours thereafter • 2) Note the number of practitioners available each day • 3) Note if the providers were asked to extend, when they were asked to extend and how many extra appointments were added. • 4) Track these numbers for two weeks and then analyze the data.

6. Data

7. Data • Available appointments at the start of the day ranged from 10-44 with a mean of 29 • 50% of the days the practitioners were asked to extend their schedule with the receptionists needing appointments by 9:30 AM • Tuesdays and Fridays seem to be the most likely days needing appointments

8. Implement Change • 50% extension rate is too much • Plan: We will implement blocked same day appointments. Each practitioner will have 2 appts. blocked in each half day of their schedule unless they are in the well child clinic • This should guarantee 16-24 appointments at the beginning of each day

9. Data

10. Data • Available appointments ranged from 16-54 at the start of the day with a mean of 32 (10% increase) • 30% of the days the practitioners were asked to extend with the receptionists needing appointments by 11:30 • Monday and Tuesday are the more difficult days

11. Implement Change • 40% reduction in extended days - we’re pretty happy • We will continue with the present number of blocked appointments anticipating we will need to increase the number as the level of illness increases with the onset of cold and flu season

12. Data

13. Data • Available appointments ranged from 6-116 at the start of the day with a mean of 38 (15% increase) • 30% of the days the practitioners were asked to extend with the receptionists needing appointments by 11:30 • Tuesday and Friday prove to be needy days again

14. Implement Change • Still feeling pretty good, the numbers are staying about the same if not a little better • We will continue with the present number of blocked appointments as we have yet to see a significant increase in illness in the community.

15. Data

16. Data • Available appointments ranged from 7-78 at the start of the day with a mean of 25 (32% decrease!) • 90% of the days the practitioners were asked to extend with the receptionists needing appointments by 8:30 - 10:00 • It didn’t matter what day this period!

18. Implement Change • We did not anticipate well for Dr. KM’s maternity leave and were very understaffed. However, by the end of the period were were recovering. • We decided to leave the number of blocked appointments the same as we were anticipating more Francis sightings over the upcoming weeks, and Dr. BM will be back from his time off with the baby.

19. Data

20. Data • Available appointments ranged from 11-45 at the start of the day with a mean of 23 (4% decrease) • 18% of the days the practitioners were asked to extend with the receptionists needing appointments by 11:30 • Tuesday once again is a consistent day needing appointments

21. Implement Change • Despite being understaffed, the numbers look better. The week of Thanksgiving was omitted due to the altered schedule during that week. • We were beginning to see an increase in respiratory illness around the community and we are understaffed, so we decided to increase the number of blocked appointments to 5 per provider for the next cycle.

22. Data

23. Data • Available appointments ranged from 19-71 at the start of the day with a mean of 44 (91% increase!) • 0% of the days the practitioners were asked to extend

24. Implement Change • We overshot this cycle with the increased number of blocks and an increased number of Francis sightings around the office. • Despite this, given the time of year, we did not reduce the number of blocks in anticipation of cold and flu outbreaks.

25. Data

26. Data • Available appointments ranged from 9-64 at the start of the day with a mean of 30 (31% decrease) • 56% of the days the practitioners were asked to extend by anywhere from 9:30 - 12:00. • Tues. and Wed. were the needy days.

27. Implement Change • We made the right choice of keeping the 5 blocks in place. Despite this, we still needed to extend over half the days. • Bronchiolitis is on the rise as well as gastroenteritis. No flu yet but should be soon. We will increase to 6 blocked appointments per provider.

28. Data

29. Data • Available appointments ranged from 16-52 at the start of the day with a mean of 29 (3% decrease) • 22% of the days the practitioners were asked to extend by anywhere from 10:30 - 12:00 • Tuesday remains the most consistent day we need appointments.

30. Implement Change • The increase in blocked appointments was successful again. We had fewer extended days despite the mean staying the same. • No planned change for the next cycle

31. What did we learn? • We were able to positively impact our ability to accommodate access for our patients through a stepwise increase in the number of dedicated same day appointments based on the level of illness in the community. • We were able to reduce the number of days our providers needed to extend their schedules to meet appointment needs. Although appointment demand is difficult to predict. • Patients had more opportunity to see “their doctor” for same day appointments.

32. What did we learn? • Tuesday is our most consistently demanding day for appointments. Is it easier for parents to miss work on Tuesday than it is on Monday? • If we have less than 5 providers on a particular day, we likely won’t have enough appointments. • Hopefully, this work will allow us to meet the standards for this section of the NCAQH