title: A new model to decrease time-to-appointment wait for gastroenterology evaluation.
abstract: OBJECTIVE
  To describe the implementation and evaluation of a quality improvement intervention to increase new-patient access and decrease time-to-appointment wait for gastroenterology care.
  
  
  METHODS
  We used a new model of care for gastroenterology evaluation. For specified clinical complaints, we offered new-patient appointments that were scheduled with a general pediatrician as an alternative to a subspecialist. A nurse navigator assisted in triaging patients. We analyzed all patient encounters over an 8-month period. To verify decreased time-to-appointment wait, mystery shoppers made semimonthly calls to centralized scheduling. We surveyed parents/families after visits with the pediatrician or subspecialists regarding satisfaction.
  
  
  RESULTS
  The "access" pediatrician evaluated and treated ∼40% of all new patients presenting to the division during the study period. Approximately 10% of new patients evaluated by the pediatrician (4% overall) were referred on to the subspecialist; fewer patients were reevaluated by the pediatrician in follow-up. The pediatrician ordered a minimal number of procedures. Semimonthly sampling revealed that overall new-patient access improved from an average time-to-appointment wait of 25 days to <1 day. Parent/family satisfaction was high for the patients evaluated by the pediatrician.
  
  
  CONCLUSIONS
  Embedding a general pediatrician within a subspecialty division, and navigating patients to this provider, can increase access to treatment of new low- to moderate-complexity patients. The access pediatrician can maintain patient satisfaction, provide high-quality care, and decrease need for subspecialist evaluation. The model, in the setting of a large academic medical center, may provide a solution for barriers to patient care such as lengthy time-to-appointment wait.
authors.affiliation: Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE 19803, USA. mdigugli@nemours.org
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Di Guglielmo
authors.forename: Joanne
authors.initials: J
authors.lastname: Plesnick
authors.forename: Jay S
authors.initials: JS
authors.lastname: Greenspan
authors.forename: Iman
authors.initials: I
authors.lastname: Sharif
mesh_terms: D000046:Academic Medical Centers / Q000458:organization & administration; D000293:Adolescent; D001071:Appointments and Schedules; D002648:Child; D002675:Child, Preschool; D003691:Delaware; D017598:Efficiency, Organizational; D005260:Female; D005762:Gastroenterology / Q000458:organization & administration*; D005767:Gastrointestinal Diseases / Q000175:diagnosis* / Q000628:therapy; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000458:organization & administration*; D018578:Hospital-Physician Relations; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D008297:Male; D010348:Patient Care Team / Q000458:organization & administration; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D010372:Pediatrics; D011320:Primary Health Care / Q000458:organization & administration; D058996:Quality Improvement; D013997:Time Factors; D014850:Waiting Lists
keywords: access to health care; gastroenterology; patient satisfaction