P2D193: Decreasing the Re-booking of Urgent General Pediatric Referrals and Developing Fast Track Ambulatory Clinics During COVID-19 Pandemic

Purpose/Objectives: During the COVID-19 pandemic, all outpatient clinics shifted to telehealth visits. However, due to the unavailability of the clinic slots, the urgent referrals were overbooked as telehealth visits and then rebooked for in-person physical evaluation if needed. This improvement initiative aims to improve the access of the urgent referrals and decrease rebooking in clinics from 60% to 30%.

Design/Methods: A cross-sectional intervention study started in October 2020 at the outpatient general pediatric clinic HMC, Qatar. The intervention was divided into two phases. In each phase, two PDSA cycles were evaluated. Figure 1 summarizes the intervention.

Results: A total of 769 urgent referrals have been screened over the last 2-years. In the first phase of the intervention, the rebooking of urgent referrals decreased from 61% to 48% over one month and dropped to 23% with the second PDSA. In phase two, two clinics were started to accommodate urgent referrals alone, decreasing the overbooking to 12%. However, during the second wave of the COVID-19 surge in May 2021, the rebooking increased to 57%. Another two PDSA cycles resulted in reducing it to 12%.

Conclusion/Discussion: Standardization reduces process waste and decreases variations that may lead to overutilization of limited resources and negatively affect patient care. Healthcare must ensure fast access to care for patients with urgent medical needs. Continuous monitoring and evaluation of outpatient referrals and booking processes are critical in ensuring high reliable quality care, especially during pandemics.