Situation: In 2015 Pediatric Consultants of Troy received the best practice award for the best overall pediatric practice. The practice needed to provide appointment at times which worked for their patients. In addition, there was a need to increase organization around patient appointments to ensure all areas were being addressed including, self-management goals, setting future appointments, and closing gaps in care.
Strategy: A solution to meeting parents' needs resulted in opening the Night Owl Pediatric Clinic to accommodate after-hour visits. The Clinic is open Sunday through Thursday from 5pm to 8pm on a walk-in basis and Saturday mornings from 8am to noon on a scheduled basis. Furthermore, after hours phone calls are returned by the physicians giving parents the reassurance they need when calling after hours. In addition, the practice has set aside same day sick appointments Monday through Friday. This schedule helped to promote continuity with the patient’s physicians. In order to prepare for upcoming visits and to ensure all areas were addressed at each visit the practice created some simple yet effective processes. Prior to scheduled visits, charts were prepared the day before. Google calendar is used for scheduling dietician, social work, and care manager appointments. In addition, a tracking process is in place which includes a checklist and tracking book. The practice team designed several patient checklists depending on the type of visit that goes to the physician to ensure that everything has been addressed such as self-management goals, medication, etc. This checklist is returned to the front staff for follow-up and gap closures as needed. For those items still requiring a follow-up, i.e. placing a call to a patient who missed their appointment or need certain tests completed are placed in a tracking book. If there is an emergency room visit the patient will receive letter with information on how to reach the practice 24/7 and their office hours, encouraging patients to call the practice first. To help close gaps in care with asthma management the practice developed two Asthma Self-Management Goal tools, one for both children nine and younger and children ten and over. An Asthma Self-Management Action plan is incorporated as well. Finally, an Asthma Navigator tool was developed to capture information up front to help determine if there is any indication of asthma or the potential for the development of asthma.