Missing Labs Performance Improvement Project 2013 Victor Chiu, Tamara Dahhan, Anishka D’Souza, Lara Hamadani, Eugene Kim, Brandon Murti, Isabela Wieczorek, Jessica Gomez K=? Na=? TSH=? LDL=? AST=? INR=? B12=? Hgb=? FOBT=? A1C =?

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

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

Process of Getting Labs When the doctor orders labs, the following happens: 1)Clerk enters labs in computer 2)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 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.

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% 6% o Wait time: <30min: 31% 30min-1hr: 40% 1-2hr: 8% >2hr: 8% 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: $350 o Per month for primary care service: $315 o 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/Ideas Housestaff education Benefit of Fasting labs Lab work process Patient education (posters, provider) o Importance of lab draws o No lab slip needed o No fasting needed unless requested Automated patient reminder system o Appointment/lab/medication list reminders

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