Patients of the St. George Pulmonary Clinic had a big access problem: They had to wait between six to 10 months before they got their first appointment at the clinic—plus managing the revolving list of more than 150 people who were waiting to be seen was inefficient and frustrating for both patients and clinic caregivers. But thanks to an innovative caregiver idea, patient wait times have now dropped to an average of just two weeks—which means patients are getting the care they need much faster.
A related problem: Toni Brown is a nurse practitioner at the clinic, and advanced-practice providers, or APPs, like her rely on physician mentoring to increase their skills. Pulmonary physicians at Dixie Regional split their week between the clinic and working in the ICU, so their time in the clinic is limited. That means Brown often had to wait for help and guidance from the physicians before she could treat her patients, which led to delays in care. The inability to align the physicians’ schedules, coupled with the need to teach and engage with APPs, led to delayed diagnoses and initiation of therapy.
“The patient experience reports showed negative comments about delays in both access and test results,” said Becky Johnson, the clinic’s practice director.
Brown felt something needed to change, so early last year she proposed a weekly case review conference between the APPs and the pulmonologists to discuss each individual case. The reviews would take up the time of two patient appointments every week, and considering the already problematic patient access issue, giving up patient appointment times seemed counter-productive. But the team agreed to give it a try.
Brown said, “I knew if I could get time with the physicians and get case information quickly, I could help more patients.” She needed something to help her feel better supported in her role; she also understood doctors needed a process that wouldn’t waste time or further delay patient care.
The weekly case reviews were more valuable than anticipated. Not only were cases put in front of pulmonologists earlier, but a tremendous amount of teaching and learning went on during the case reviews. Each patient’s case received dedicated discussion time in the conference and was reviewed by both the physician and APP. Within a month after starting case review conferences, the St. George Clinic initiated a new process to have most new patients seen by APPs first. So patients are seen sooner and get test results more quickly.
“The loss of two appointments was actually an incredible gain,” Johnson said. “Working to improve access previously meant we needed more patient appointments. We had to think outside of the box and stop limiting ourselves.”
Both Johnson and Brown agree that quality hasn’t decreased even as the clinic has accommodated more patients—if anything, it’s increased. “Even in its infancy, the program is easy to sustain because it focuses on standardization and best practices,” said Johnson. “Case review allows for a comprehensive commitment to the highest standards of care while embracing opportunities for improvement. Wait times are now only about two weeks and the list of patients who are waiting to be seen is down from 150 to 25.”
“What felt impossible became possible through the St. George Pulmonary Clinic’s team-based efforts to find better ways to care for patients,” Johnson said.