By implementing a new appointment and scheduling process and expanding imaging hours, personnel at a U.S. Department of Veterans Affairs (VA) medical center in Virginia have significantly improved patient access to MRI services, according to a study presented at the American College of Radiology's ACR 2015 meeting last week in Washington, DC.
In-house scheduling, patient appointment reminders, and additional staff to accommodate extended imaging hours at the Hampton VA Medical Center were among the actions that collectively reduced appointment "no shows," the average wait time for an MRI scan, and reading turnaround time.
The changes offer a blueprint which, if implemented throughout the VA system, could help reduce the long patient wait times that have cast a black mark on the VA system over the past several years.
Horror stories
Horror stories of U.S. veterans waiting months and even years for medical appointments came to light in 2014 with news reports stating that as many as 40 veterans died waiting for services at the Phoenix VA hospital. Delays were common at other facilities as well. The deficiencies prompted the U.S. Congress to pass the Veterans Access, Choice, and Accountability Act of 2014 to improve access to timelier clinical care. One key provision of the law mandates that veterans can receive healthcare from providers outside the VA system if wait times for VA care exceed 30 days.
In October 2013, even before the law was enacted, staff at Hampton VA Medical Center began to change patient policies to improve MRI services.
Dr. Mary Huff from Eastern Virginia Medical School."From our perspective, we've always been concerned about patient access to care, so it was something we were very interested in," lead author Dr. Mary Huff, chief resident in the department of radiology at Eastern Virginia Medical School, told AuntMinnie.com.
One of the first bottlenecks to solve was a process by which a centralized VA office handled scheduling for all area clinics. The method led to overbooking or underbooking, with little or no contact with patients to remind them of appointments.
"Unfortunately, not all the clinics have the same kind of scheduling," explained study co-author Dr. Jose Morey, staff radiologist and radiation safety officer for the Hampton VA Medical Center. "We don't all take patients every 15 or 30 minutes in a standardized way. Our [appointments] are based on need, depending on the procedure, which can take time."
Given the situation, the Hampton facility "decoupled" from the main scheduling office and hired its own scheduler in late 2013 to handle patient appointments, Morey said.
The facility's new appointment process includes an initial screening questionnaire completed by the ordering physician at the time of consultation or order entry in the electronic medical record, a daily radiologist review of consultations, and a daily MRI technologist screening of approved consults.
In addition, if a patient has not scheduled an appointment within seven business days of the consultation or order entry, the medical center mails a postcard reminder to the patient and follows up with a phone call three days before the appointment.
In addition to the scheduler, the medical center also hired another technologist and radiologist to help implement the new procedures and extend MRI scanning hours from five days to six days a week (excluding Sundays). Morey said the MRI suite is "booked solid" during those six days from 6:30 a.m. to 8 p.m., and 20 to 30 patients are scanned per day, depending on the complexity of the cases.
The changes helped the facility improve its performance across a variety of metrics, such as its no-show rate, reading turnaround time within 24 hours, and average wait time from order entry to appointment.
| MRI scheduling at Hampton VA Medical Center | ||
| Metrics | 2012 | 2014 |
| No-show rate | 9.4% | 4.8% |
| Reading turnaround time ≤ 24 hours | 68.9% | 95.1% |
| Average wait time | 70.5 days | 29 days |
Given the success of the initiative, the facility plans to expand the process to other imaging modalities and departments.
"One of our purposes for this study is to provide an example of how one facility was able to do this," Huff said. "We are hoping this [protocol] can expand through the VA to other university settings and private practices to model a way to change patient access to care, turnaround time, wait times, and reminders for patients so they are aware of their appointments."
