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• W3128250432 abstract "Background: Multidisciplinary clinics are the hallmark of cystic fibrosis (CF) care, but more experts often add time to the clinic visit CF clinic appointment time at our institution extended to 170 minutes with approximately 6-8 disciplines per patent To embed recent CF Foundation- supported scholars from Endocrinology (ENDO) and Gastroenterology (GI) into clinic, we sought to streamline visit time for patients and families without compromising multidisciplinary care Objective: To maintain coordinated multidisciplinary clinic visit time at 120 minutes with the addition of ENDO and GI specialists after October 2019 Methods: A multidisciplinary quality improvement team including 2 parent partners met weekly to organize the initiative We surveyed the CF clinic team to rank perceived barriers We asked families perceived barriers to clinic through an added question on our clinic intake form and a survey to our Parent Advisory Council Using pareto charts, we developed interventions to target most common barriers: 1) clinic road map to communicate across team which disciplines have priority patient assessments, 2) facilitator to decrease wait time between providers, 3) nurse-doctor (RN-MD) paired visits for shared communication and earlier RN sign-out of families We tested interventions with plan-do-study-act (PDSA) cycles We met hospital administrators monthly to accommodate PDSA cycles and adjust templates and rooms as needed A subset of clinics were timed and displayed on a run chart monthly with interventions annotated Visit time was compared before (5/2019-8/2019) and after (10/2019-3/2020) integration of ENDO and GI into clinic Results: Survey of team members' perceived barriers to clinic had 24 responses Most parent responses (14 of 19) reported concerns of wait time or visit length PDSAs started in June 2019 before integration of ENDO and GI Road map PDSAs adapted processes for improved use and integration of the tool Clinic facilitator role was adopted with a medical assistant in the role RN-MD pairs had positive feedback from both RNs and MDs Prior to PDSAs, average clinic visit time was 127 minutes Of 18 timed clinics, 7 had ENDO/GI provider present Prior to ENDO and GI integration, clinic visit time was reduced to average clinic visit time of 121 minutes Following integration, clinic visit time was maintained at 121 minutes Proportion of clinic visit spent between waiting between team members was 26% (total time=31 minutes) which was also stable to slightly improved to 23% (28 minutes) after integration of ENDO and GI Team members reported high satisfaction with all clinic visits finishing on time post-integration Some families informally shared high satisfaction/noticeable change in duration of clinic visits Conclusion: Interventions designed to address barriers in clinic flow demonstrated improvement in clinic visit time despite embedding 2 new subspecialists COVID-19 limited further PDSAs for in-person clinic visits, however poises our team to address care coordination and communication for hybrid in-person and virtual models" @default.
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• W3128250432 date "2020-01-01" @default.
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• W3128250432 title "Reduction of CF clinic visit time: A singlecenter quality improvement study to incorporate more subspecialists in clinic" @default.
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