A Quality Improvement Approach to Ensuring Access to Specialty Care for Pediatric Patients

Introduction: With pediatric rheumatologists in short supply, maximizing appointment availability and streamlining primary/specialty collaboration are essential. Lack of an efficient referral process impacts outcomes, quality of life, satisfaction, affordability, and resource allocation. Before this quality improvement project, our clinic had a 3- to 5-month backlog for new referrals. Methods: Using the model for improvement with numerous rapid-cycle plan-do-study-act cycles, this team restructured processes, developed a triage tool for communication across the care continuum, maximized staff roles in multiple areas, and instituted cross-disciplinary communication strategies to reduce appointment delays while significantly increasing efficiency. Results: The team succeeded in decreasing time from referral to specialty consult by 60%, decreasing no-show rates from 15% to 6%, and increasing throughput by an average of 45 more patients per month. Most new patients can now see our specialists within 23 days, meaning the children in our community have 65% shorter wait times for rheumatology services. Conclusion: The use of a triage algorithm with structured communication allows multidisciplinary care teams at both the referring and receiving providers to efficiently and accurately place patients into specialty care. This highly scalable and transferable project was accomplished with no direct financial outlay yet yielded significant returns by standardizing processes, empowering the entire care team to build skills, and improving communication.