January
2003
Volume 27 •
No. 1
School of Medicine launches new institute to study stem cell, cancer biology
Stanford, Packard hospitals and SEIU agree on new contract
Clinical trial studies vastly shorter radiation time for breast cancer treatment
For 3 decades, radiation oncologist has played leading role in field's evolution
Access to Stanford physicians fast-tracked with IMPACT
New procedure aims to boost proper use of observation status
Community physicians respond to changes in appointment, promotion criteria
Access
to Stanford physicians fast-tracked with IMPACT
Stanford Hospital & Clinics, a charter member of the nonprofit Institute
for Healthcare Improvement IMPACT collaborative, has joined with nearly
100 hospitals, health-care groups and delivery systems to improve their
organizations with two major initiatives: "Improving Care in Office Practice
and Outpatient Settings" and "Improving Flow Through Acute-Care Settings."
Just over a year ago, Stanford primary care clinics joined another IHI quality-improvement initiative called Advanced Access and Efficiency. That program helped the clinics achieve huge gains in patient access to physicians. Over the next two years, the clinics will further these efforts by addressing the six dimensions of quality called for in the Institute of Medicine's "Crossing the Quality Chasm" report. An arm of the National Academy of Sciences, the institute challenges health-care institutions to boost effectiveness, efficiency, patient safety, timeliness and equity.
"IHI's mantra is to give all patients exactly what they need when they need it," said Joseph Hopkins, associate chief of staff for Stanford Hospital & Clinics and clinical professor of medicine. "If you solve access, you dramatically improve the patient experience."
The Stanford Family Practice and Stanford Medical Group clinics have made significant improvements in service over the past year. Before Advanced Access, patients were accustomed to waiting anywhere from 18 to 100 days for an appointment, and scheduling an appointment often took two or more calls. Today, nearly all patients can be seen the same day they call, after phoning just once. Because of the improved access, the no-show rate has decreased from 11 percent to about 5 percent, said Hopkins.
The newer IMPACT project will help these clinics build on past successes. For starters, the clinics are developing a quality-improvement initiative to care for patients with diabetes. They are also addressing patient safety and efficiency of patient flow. One area slated for improvement is the amount of time patients spend waiting in the office after arriving. The goal, said Hopkins, is to encourage patients to arrive 15 minutes earlier so they can register, take care of insurance information, have vital signs taken and get settled before the doctor arrives.
The success of Advanced Access in the primary care clinics led the project team to expand its quality efforts into the gynecology and gastroenterology clinics this past October. "We looked for clinics that needed improvement and had strong clinic managers and physician chiefs," said Hopkins. "It's a credit to these clinics' leadership that they recognized the need to improve and did something about it."
At the Gastroenterology Clinic, where many patients suffer from chronic illnesses such as irritable bowel syndrome, the IMPACT team is studying how to manage its high number of return patients. One idea is to develop an educational program to improve self-management techniques, which would reduce patients' need to visit the clinic as often. Sandra Rozmarin, quality manager for Stanford's adult clinics, noted that the Gastroenterology Clinic already has decreased patients' wait time for appointments from 38 days to 17 days.
Similar efficiency-enhancing programs will eventually spread to other areas of Stanford Hospital & Clinics, including the operating rooms, the Anesthesia Recovery Unit and the Surgery Admission Unit. The goal, said Hopkins, is to have IMPACT principles spread across the entire continuum of care, from patient admission to discharge.
