PC1003: Improving Continuity in Pediatric Ambulatory Clinics

Purpose/Objectives:

Purpose: The ambulatory continuity clinic is an essential part of the pediatric residency and gives physicians in training their first exposure caring for patients and their families longitudinally. Consistent continuity not only provides optimum education and clinical experience for the residents, it improves patient flow, efficiency of the clinic and enhances patient experience, their adherence to medical care, and improves patient outcomes. The Graduate Medical Education (GME) requirements mandate that every accredited program in Pediatrics must ensure that residents have protected time of at least one half day per week, even during their inpatient and specialty rotations for their longitudinal clinic. Despite these requirements, there does not appear to be much research or information available how well the continuity clinics are structured, these mandates implemented nor the extent that this continuity contributes to the residents’ education and enhancement. At our pediatric residency program at University of South Florida (USF), we strive to ensure that the goals of the continuity clinic are met, and the residents get a reliable experience with repetition with the same patients and families, that allows them an opportunity to build meaningful relationships with families over the duration of their residency.

Design/Methods: Methods: We decided to evaluate residents’ attitude and satisfaction with their continuity clinic. Our survey also invited input about any perceived barriers to patient scheduling and retention and collected information about various strategies currently utilized to improve the rate at which patients follow up with the same resident. We have 2 major sites where the residents are scheduled for their ambulatory clinics - one managed by the university system and the other run by the main affiliated teaching hospital. The Teaching Faculty pool is common at the 2 sites. This setup provided an opportunity to compare the 2 groups within our institution.

Results:

Results: Overall most residents (84%) were satisfied with their continuity clinics; however, the resident satisfaction and experience was much better at the university clinic and there were several areas of improvement that were identified. Residents shared their own perspectives and offered suggestions that they would like to see implemented to improve follow-up in their clinics.

Conclusion/Discussion:

Discussion: In order to improve the continuity experience, we implemented several small changes- at every level in the clinic- from scheduling personal, nursing staff, administrators, EMR, teaching faculty and residents themselves. We believe that this has already brought improvements in the continuity clinics. We met some barriers to these processes including high staff turnover at our hospital-managed site as well as structural limitations in the EMR. We will soon be implementing our second round of surveys, one year following the start of the project, and start a new cycle of improvement.