Access Hero: Reducing derm care wait times at safety net hospitals

By Benjamin F. Chong, MD, MSCS
Parkland Health and Hospital System

 
Learn how Dr. Chong's clinic reduced wait times for patients. Read more at SkinSerious.

Resources available to outpatient dermatology clinics at safety net hospitals, which provide care to uninsured and underinsured patients, have not been well characterized. The care given at these institutions is often uncompensated, making the need for efficient use of already limited resources even more pertinent. To better understand where these precious resources are used, my colleagues and I developed a cross-sectional survey to assess resource allocation in outpatient dermatology clinics at safety net hospitals. Although the sample size is small, we found notable gaps in patient wait times and staff productivity.

We designed a 42-question cross-sectional survey to assess staffing, patient volume, appointment wait times, and medical services offered at outpatient dermatology clinics in safety net hospitals that are affiliated with dermatology residency programs in the United States. We deployed this survey nationally via email to 50 safety net hospitals; we received a 62 percent completion rate.

Our survey revealed that each half-day outpatient dermatology clinic had a median of 48 appointments scheduled daily with a median no-show rate of 30 percent. High no-show rates in these clinics are likely due to patients’ transportation constraints and their inability to leave work for appointments. For the safety net outpatient clinic, this translates to longer wait times for new patient appointments. Our survey revealed a mean wait time of 45 days for a safety net outpatient clinic appointment, 16 days more than the average wait time reported by all AAD members in a separate survey conducted in 2014.

These wait times are also affected by staffing shortages. Although optimal staffing for outpatient dermatology clinics is not known, staffing ratios reported by safety net dermatology clinics are less than ideal. Providers outnumber support staff indicating a need for additional nursing staff, which can improve productivity and reduce wait times.

At our clinic at Parkland Health and Hospital System, hiring an additional nurse led to a 31 percent decrease in wait times. We also implemented other key changes to improve clinic efficiency, including: discharging stable, low acuity patients to their primary care doctors’ care; reorganizing our clinic schedules to have consistent numbers of new and follow-up patients; designating a resident to perform all biopsies; and hiring a physician assistant to handle low-acuity dermatology cases. Ultimately, these changes reduced new and established patient wait times from 377 days to 48 days, and from 95 days to 34 days, respectively.

At Parkland, we’ve worked to make changes to improve the allocation of our resources and hope the results of our survey can help other safety net dermatology clinics make similar adjustments. You can read the full results of our survey in the November issue of the Journal of the American Academy of Dermatology.