Quality Improvement Project to Reduce Wait Time for Pediatric Gastrointestinal Procedures
Jennifer M Colombo1,2, Nicholas A Clark2, Laura E Shroyer1,3
1From the Division of Pediatric Gastroenterology, Department of Pediatrics, Children's Mercy Kansas City, Kansas City, Mo.
Insights
Reducing gastrointestinal endoscopic procedure wait times by 82% improved patient satisfaction by 26.4%. This study highlights successful A3 problem-solving for timely healthcare access.
Area of Science:
- Healthcare Operations
- Quality Improvement Science
- Gastroenterology
Background:
- Delays in healthcare access negatively impact patient outcomes and experiences.
- Long wait times for gastrointestinal endoscopic procedures are a significant challenge.
- Optimizing patient flow is crucial for efficient healthcare delivery.
Purpose of the Study:
- To significantly reduce the average wait time for gastrointestinal endoscopic procedures.
- To improve patient satisfaction regarding the timeliness of care.
- To implement and assess the effectiveness of the A3 problem-solving methodology in a clinical setting.
Main Methods:
- Utilized the A3 problem-solving methodology, centered around a multidisciplinary improvement workshop.
- Tracked outcome measures: wait time (request to completion) and patient satisfaction scores.
- Monitored process measures (scheduling efficiency) and a balancing measure (procedures per weekday) using control charts.
Main Results:
- Achieved an 82% sustained reduction in average wait times, from 145 to 26.4 days.
- Increased patient satisfaction with timeliness of access by 26.4% (from 39.7% to 50.2%).
- Reduced internal process times for scheduling and procedure completion by 74% and 77%, respectively, without affecting procedure volume.
Conclusions:
- The A3 problem-solving methodology effectively reduced endoscopic procedure wait times by 82%.
- Concurrent improvements in patient satisfaction were observed, demonstrating the value of targeted quality improvement initiatives.
- Procedures are now consistently completed within one month of the request date, enhancing patient care delivery.
Introduction:
Delays in care can lead to poor health outcomes and suboptimal patient and family experiences. We aimed to reduce the average wait time for gastrointestinal endoscopic procedures (procedure request to procedure completion) from 145 to 15 days (a 90% reduction) within 4 months (November 2023 to March 2024).
Methods:
A3 problem-solving methodology was used. The primary intervention was a multiday, multidisciplinary improvement workshop. Outcome measures included (1) procedure request date to procedure completion date, and (2) favorable patient satisfaction score for timeliness of access to care. Process measures included (1) procedure request date to date procedure scheduled by staff, and (2) date procedure scheduled by staff to procedure completion date. The balancing measure was the number of procedures scheduled per weekday. Control charts assessed the impact of interventions.
Results:
Following the primary intervention (October 2023), special cause improvement was seen for all but the balancing measure. Outcome measure 1 achieved a sustained reduction in mean monthly wait time from 145 to 26.4 days (an 82% reduction), whereas outcome measure 2 achieved sustained improvement in patient satisfaction from 39.7% to 50.2% (a 26.4% relative improvement). Process measures 1 and 2 had sustained reductions from 56.5 to 14.7 days (a 74% reduction) and 89.1 to 20.7 days (a 77% reduction), respectively. The balancing measure also remained unchanged at a monthly average of 11.7 procedures scheduled per weekday.
Conclusions:
Using A3 problem-solving methodology, we achieved an 82% sustained reduction in endoscopic procedure wait times with a concurrent 26.4% improvement in patient satisfaction. Procedures are now routinely completed within 1 month of the request date.