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Apr 5, 2016 - Richard H. Epstein, M.D.1, Anantha Gangadhara, M.S.2, Gardy Excellent, M.B.A.3, Dora Maya, M.A.3, Daniel. Fleisher, M.B.A.4, David Aribu, ...
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Control/Tracking Number : 16-A-3691-ASAHQ Activity :Abstract Current Date/Time : 4/5/2016 3:59:58 AM TITLE: Open Access to New Patient Appointments in a Chronic Pain Clinic Reduced Lag Times and Cancellation Rates, and Improved Utilization AUTHOR(S): Richard H. Epstein, M.D.1, Anantha Gangadhara, M.S.2, Gardy Excellent, M.B.A.3, Dora Maya, M.A.3, Daniel Fleisher, M.B.A.4, David Aribu, Not Applicable2, Steve Williams, M.B.A.1, Chaturani T. Ranasinghe, M.D.1, Konstantine D. Sarantopoulos, M.D.,Ph.D.1, David A. Lubarsky, M.D., MBA1. 1

Anesthesiology, Perioperative Medicine and Pain Management, University of Miami, Miller School of Medicine,

Miami, FL, USA, 2University of Miami, Miller School of Medicine, Miami, FL, USA, 3University of Miami, Miami, FL, USA, 4University of Miami Miller, School of Medicine, Miami, FL, USA.

AFFIRMATIONS: Affirmations Cont. (Complete): I Agree: True

*: I agree to the above statements *: Yes *: No animal subjects were involved in the research *: No human or animal subjects were involved in the research If IRB approval is not required, please explain why in 2 to 3 sentences. : not human subjects research per federal guidelines

SESSION CATEGORY: 03.2 CHRONIC AND CANCER PAIN - Clinical

QUESTIONNAIRE: Questionnaire (Complete): Please select : No, do not consider my abstract for the ANESTHESIOLOGY Journal Symposium Is this abstract submitted by a resident?: No

Funding Information: No External Funding Yes or No?: No

ABSTRACT: Introduction: Outpatients who fail to show up for appointments negatively affect clinic financial performance and reduce other patients' access to care. The interval between the date of scheduling and the visit (appointment lag) is positively correlated with cancellation rates.1-4 Patients with chronic pain often have long delays until they can be seen by a pain specialist (e.g., 2-6 months).5-7 At our pain clinic, the new patient cancellation rate was ~35% and the appointment lag was 12.5 days with a scheduling paradigm that only allowed a fixed daily number of new patient evaluations. We implemented a change to allow new patients to have an appointment on a weekday of their choosing, regardless of the already scheduled clinic workload. This was accomplished by double-booking some new appointment slots in order to mitigate the high cancellation rate. This access was not offered to established patients. We hypothesized that improving access would lower the appointment lag and decrease the cancellation rate. Methods: De-identified data related to appointment scheduling and clinic appointment arrival were obtained electronically from the hospital’s enterprise EMR (Epic) between April 2014 and December 2015 (12 months baseline, followed by 9 months open access). We defined a cancellation as a patient who either failed to show up or cancelled within 1 business day of the appointment. Data were binned by month and values during the baseline period were compared to the open access period using the method of batch means and the 2-sided Student’s t-test. Results: During the open access period, lag times decreased by 5.1 days (95% CI 3.0 to 7.1 days, P=0.00007) from the 14.1 day baseline in the new patient group, but were unchanged in the established patient group from 22.1 days (difference = 0.2 days, P = 0.8). The new patient cancellation rate decreased by 4.0 % (95 % CI 1.2% to 6.8%, P=0.005) from a 35.7% baseline rate (Fig. 1), but was unchanged in the follow-up patient group (28.8% vs 27.1%, P=0.2). During the baseline and open access periods, new patients were more likely to cancel than established patients, 35.7% vs 28.8%, (P=0.00007) and 31.7% vs 27.1% (P=0.001), respectively. Utilization of clinic appointment slots increased by 11.3% from 84.3% to 95.6% (95% CI 7.3% to 15.4%, P=0.0001)(Fig. 1) .

Figure 1. Cancellation Rates and Appointment Utilization. .

Discussion: In our pain clinic, providing new patients with access to an appointment on a weekday of their choosing was associated with a small but significant decrease in the lag time and the cancellation rate, and an increase in clinic utilization. Despite this intervention, the overall cancellation rate remained high, suggesting that providing open access is a minor factor influencing the likelihood of patients showing up for their appointment. Furthermore, the small performance improvements resulted, anecdotally, in some double-booked patients expressing dissatisfaction about not having been seen at their scheduled time. We are currently investigating methods to better predict patients likely not to show up for their appointments in order to better manage patient flow, maintain expedited access for new chronic pain patients, and to reduce tardiness of clinic appointment times. References: 1. Festinger DS et al. Addict Behav. 2002;27:131-7 2. Moser SE. Fam Pract Res J. 1994;14:281-8 3. Sharp DJ et al. BMJ. 2001;323:1081-2 4. Bean AG et al. J Health Care Marketing. 1992;12:14-25 5. Davies HT et al. Anaesthesia. 1994;49:661-5 6. Lynch ME et al. Pain Res Manag. 2007;12:245-8 7. Lynch ME et al. Pain. 2008;136:97-116

SUMMARY: We implemented a change in our chronic pain clinic to provide open access to new patients for an appointment on a weekday of their choosing, regardless of the already scheduled workload. This was accomplished through selective double booking of appointments to mitigate our current cancellation rate of 35.7%. This intervention reduced the cancellation rate by 4% and the appointment lag time from 14 to 9 days, both statistically significant, but of marginal benefit. Although clinic efficiency was increased, some patient dissatisfaction was expressed from delays in being seen from the scheduled appointment time.

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