A Redesign of the Biopsy Scheduling Process: Improving Care through Standardization

Introduction: Standardization of work is the method for developing best practices. After the heart transplant team completed a gemba of the current scheduling process, we identified several opportunities for improving how we schedule office visits and endomyocardial biopsies for heart transplant recipients. Hypothesis: Developing a standardized process for scheduling office visits and biopsies for heart transplant recipients will result in safe, consistent delivery of care with less rework leading to improved quality of care as well as an increase in patient and staff satisfaction. Our goal is to see a 50% reduction in errors in office visit and biopsy scheduling over the next 6 months. Method: We implemented a process which there is a dedicated nurse communicating to the cardiac catheterization laboratory (cath lab) on a weekly basis. A master calendar was created, with dedicated days in the cath lab for transplant recipients. The nurse coordinators add their patients to the master calendar. Every week, two consecutive months of biopsies needed are sent to the cath lab scheduler. The medical assistants also receives information so pre-biopsy clinic visits are scheduled. The central authorization team is made aware and provided the tentative schedule in order for authorization to be obtained for multiple procedures to avoid delays in scheduling the biopsy procedure. In advance, we provide the patients with potential dates of their biopsy procedure. All communication regarding biopsy scheduling and medication adjustments are made in one phone call to patients. Results: There was a significant decline in scheduling errors for office visit from 41% to 30% over the last six months. Also we saw a decline in biopsy scheduling errors from 39% to 26%. Table 1. Marked improvement in patient satisfaction was demonstrated by a patient survey. Table 2. Conclusion: To deliver safe, reliable, effective care standardization and kaizen (continuous improvement) must occur. Implementation of our new scheduling process has resulted in more timely, efficient, effective and patient-centered care for our transplant patients