title: Using patient traffic control to reduce treatment delays for high-risk patients at a VA hospital.
abstract: BACKGROUND
  For patients at high risk of function-limiting or life-limiting disease, the time elapsed between first clinical presentation, diagnosis, and treatment can influence the likelihood of treatment success.
  
  
  METHODS
  A systematic change in the management of high-risk patients was undertaken. This approach includes identifying primary provider responsibility, establishing communication expectations between providers, developing a tracking system to actively monitor patients (patient traffic control), and using a time guideline to assess patient progression. A 60-day time frame was established for the time from first clinical presentation to diagnostic exclusion or treatment initiation.
  
  
  RESULTS
  In a one-year period, 288 high-risk patients were entered into patient traffic control, 211 (73%) of whom were monitored in the primary care setting. The median time to diagnostic exclusion or treatment was 43 days (mean, 58.5 days). Sixty-six percent of all patients achieved diagnostic exclusion or treatment by 60 days. Of the 95 patients monitored for > 60 days, 56% had delays caused by patient noncompliance or because of the appropriate need for long-term serial radiographic monitoring. Thirty-eight patients (13.1%) demonstrated problems with appointment nonadherence. None were lost to follow-up.
  
  
  CONCLUSIONS
  The patient traffic control approach enabled the management of the majority of high-risk patients within 60 days of presentation.
authors.affiliation: Medicine Service Line, Hines Department of Veterans Affairs (VA) Hospital, Hines, Illinois, USA. brian.schmitt2@med.va.gov
authors.forename: Brian P
authors.initials: BP
authors.lastname: Schmitt
authors.forename: Lynn
authors.initials: L
authors.lastname: Hoffstadter
authors.forename: Sandra
authors.initials: S
authors.lastname: Greider
authors.forename: Kitty
authors.initials: K
authors.lastname: Thomas
authors.forename: Estrella
authors.initials: E
authors.lastname: Calubaquib
authors.forename: Edna
authors.initials: E
authors.lastname: Montgomery
authors.forename: Gail
authors.initials: G
authors.lastname: Robinson
authors.forename: Bruce
authors.initials: B
authors.lastname: Guay
authors.forename: Nirmala
authors.initials: N
authors.lastname: Bhoopalam
authors.forename: Barbara
authors.initials: B
authors.lastname: Temeck
mesh_terms: D003142:Communication; D003266:Continuity of Patient Care / Q000458:organization & administration*; D006297:Health Services Accessibility / Q000458:organization & administration; D006787:Hospitals, Veterans / Q000458:organization & administration*; D006801:Humans; D011785:Quality Assurance, Health Care / Q000458:organization & administration*; D012306:Risk; D013997:Time Factors; D014481:United States