Urgent Care: Care Delivery Model Change

Learning outcomes are quality improvement strategies to increase efficiency, care delivery, and patient experience in an urgent care. Urgent care’s patient experience key indicator scores were in the zero percentile, patients had three hour waits, and the providers often had a backlog of patients. Patient perception of care with how we worked together as a team scored low, which was evident with poor continuity of care throughout visits and long wait times. The current state care model involved providers seeing the next patient in order of arrival, during or after finishing up care of a patient. In evaluating our operations, it was clear that some care model changes were needed to create a better experience for our patients and our team. In addition to reviewing our internal operations, we also visited other facilities who provided similar care.
As a team we utilized the A3 continuous improvement process to guide changes to our care model. The cross-functional team included patient service representatives, medical assistants, nurses, APPs, MDs, and local level leaders. The team met weekly to discuss current state challenges including fairness of workload, processes around rooming patients, consistency and communication of care, and patient assignments. We learned that we should pair a provider, nurse, and medical assistant with set of exam rooms and assign patients as they walk in, rotating assignments to reduce influx of patients. This adjustment holds staff and providers accountable for a group of patients as well as increase consistency of who is caring for the patient. We would pull until full into open exam rooms without needing a provider to pick up the patient, reducing rooming delays and wait times. We performed small tests of change and trialed this idea before making it operational. We learned in trialing that having set exam rooms near each other was needed to maximize efficiency from a space and logistical standpoint, which also included moving supplies near each work area.
We have a visual management huddle board that we start every day at to discuss our day ahead and any changes. This board offers a place for staff to provide feedback on this new model for what is working well and any additional improvement opportunities. We also utilize this board to display our patient experience scores and comments.
Four months after implementing this change, our patient experience key indicator scores increased. In the category of likelihood to recommend clinic, we rose from 0% to 34% and in category of staff working together as a team, we rose from 7% to 47%. Our charge nurse average end time decreased from 43 minutes past scheduled end time to 13 minutes past scheduled end time. The vacancy rate has decreased in nurses from 17.1% to 9.8% and in medical assistants from 30% to 17.5%. Our ongoing success was supported by the continued meetings which have phased from weekly to biweekly to monthly as feedback wanes and opportunities for improvement decrease. We continue to seek opportunities improve.