1. ROSE FAMILY MEDICINE RESIDENCY ANIBAL MARTINEZ, MD VANESSA ROLLINS, PHD Implementing a same day appointment policy

2. OUR HISTORY OF NO-SHOWS 3 no-shows and dismissal policy Review of patients recommended for dismissal Unintended side effect Front desk and providers frustrated with having to refer patients to ED/urgent care Decreased patient satisfaction and continuity

3. And PCMH PCMH 1A.1  Providing same day appointments  For routine and urgent care  Adding ad hoc or unscheduled appointments to a full day doesn’t count

4. Open Access Team Team consisted of providers and front desk staff Chose no-show rate as our success metric Began first PDSA cycle  How many open access visits do we need?  Needs to be meaningful enough to have impact on no-show rate  Should we specify limits for acute and chronic?  Significant concern about “wasted” appointment times and residents not meeting numbers  Will there be one “open access” provider per day?  How do we assign the same-day slots?  Patient outreach  Initiated by patient  Triaged by someone  Providers struggled early on with belief that same-day should be for acute only  Affect on the current acute and overbook policies  Concerns about scheduling systems issues

5. Open Access Team Test case of 2 residents who were close to maternity leave (acutes only) Decided to gather data by having front desk staff tally numbers of same-day appointment requests (acute and chronic) for 2 weeks Front desk team member instrumental in engaging her colleagues in the task

6. Front Desk Data More Chronic than Acute. Total of 103 request in 2 wks 1 slot needed/resident/half day

7. Open Access Pilot Piloted one open access slot at 10am and 3pm for PGY-2s and PGY-3s only Expanded to 3 open access slots/per resident/day a month later The only criteria: patients must call at 8am and filled first come first served

8. Typical resident schedule

9. Open Access Results No-show rates for open access approximately zero to two per week. All open appointments typically filled within an hour Constant communication between providers and front desk to assess effectiveness and needs Two months after pilot, no show rate down from 21% to 18%

10. How are we doing now? Troubleshooting Currently demand from hospital/ER follow up necessitating using open access slots Soon 3 PGY-3s will have 2 open access a.m. and p.m. By provider consensus, front desk can move open access slot to a time more convenient for the patient Haven’t been able to easily calculate “time to 3 rd next available appointment” Would like to collect objective patient satisfaction data about open access

11. Open Access Impact Decrease of No Show rates one percentage point

12. QUESTIONS HOW HAS YOUR PRACTICE DEFINED OPEN ACCESS? WHAT CHALLENGES HAS YOUR RESIDENCY FACED IN IMPLEMENTING AND MAINTAINING OPEN ACCESS? Any impact on patient satisfaction?