Krishna, Bipinchandra Hirisave

Mayo Clinic Health System — Southwest Minnesota Region, one of four practice regions in the Midwest, provides primary and speciality care in ambulatory, procedural and hospital settings. Clinic appointment fill rates, no-show rates and late cancellation rates are closely monitored operational metrics, but at the time this study began, less was known about the refill rates of late appointment cancellations. This metric is of importance because these unfilled appointment times contribute to increased expenses for healthcare organisations, unnecessary delays in care and decreases in revenue. The main objectives of this study were to understand the current state and potential opportunities for refilling late cancellations. Qualitative and quantitative methods were used, including variance analysis, the Tukey post hoc test, Pareto analysis, the completion of interviews with important stakeholders and data extraction from the institution’s electronic health record. Findings showed that late cancellation rates remained steady in 2021 and that late cancellations were not being refilled consistently across departments and regions. Appointment refill rates were higher in departments with few or no requirements for preparatory evaluation, whereas in specialties that did require preparatory evaluations, refill rates were lower across the four regions of the Mayo Clinic Health System. Even in departments with high demand, the refill rates were lower, resulting in missed opportunities for patient visits. Mapping the workflow for late cancellations indicated inconsistent methods for refilling late cancellation openings and the lack of a defined process for refilling them that was understood by the entire care team. The logistics of optimising refill rates for late cancellations were affected by provider preference, selfscheduling functionality and appointment requirements. This study identified opportunities for optimising workflows to use the waiting list proactively to refill late cancellations.

The COVID-19 pandemic caused a transformation in healthcare delivery at a pace never before experienced, including by the child psychiatry practice at Mayo Clinic Health System in Mankato, Minnesota. The aim of this study was to describe the outcomes of that practice’s transition from in-person to virtual care. This retrospective study comprised two groups of patients who received care in the child psychiatry practice at our institution: before COVID-19, 1 March 2019 to 28 February 2020; and after COVID-19, 1 March 2020 to 28 February 2021. We extracted data related to patient visits from the electronic health record and satisfaction data from a Medical Practice Survey given to patients after visits. Virtual visits increased by 306 per cent within a month of transitioning to virtual care and remain the main visit type for established patients. Findings from patient surveys showed substantial overall improvements in patient experiences with virtual visits, and no-show appointments decreased substantially (from up to 23 per cent to 1 per cent). This study provided data for an overview of how the COVID-19 pandemic affected a child psychiatry practice and of the positive outcomes of transitioning from 100 per cent in-person visits before the pandemic to more than 80 per cent virtual visits. The quick transition to virtual care delivery in the child psychiatry practice was a positive change for patients, families and the care team. We believe that other healthcare systems can learn from our experience.

Introduction: The coronavirus disease 2019 (COVID-19) pandemic has impacted health care organizations throughout the world. The Southwest Minnesota Region of Mayo Clinic Health System, a community-based health care system, was not immune, and in March 2020, our outpatient services were deferred and decreased by 90%. Method: This article is a review of the approach we used to safely reactivate outpatient care, the tools that we developed, and the outcomes of these reactivation efforts. A novel Outpatient Practice Reactivation Framework was established and used that included Outpatient Clinic Appointment Dashboard, Decision Matrix, Access Management, Virtual Care, and Patient Safety. This framework was guided by patient demand for care and by safety principles, as recommended by state and federal agencies and our internal infectious disease department guidelines. Results and Conclusions: Over the course of 9 weeks, ambulatory visit volumes and clinic utilization rates returned to pre-COVID levels (Pre-COVID fill rate range: 87% to 94%, post-COVID fill rate range: 86% to 89%) exceeding target fill rate of 80%, as a result of establishing the initiative as a shared priority, committing to a robust schedule and decisive actions, creating and maintaining a well-defined structure, taking an inclusive approach, overcommunicating and providing sufficient data for transparency, developing guiding principles, and training and educating staff.