New rapid-access model reduces outpatient neurology wait times

UCLA Fast Neuro helps keep patients with nonemergent neurologic complaints out of the emergency department.

In January 2019, a team from the UCLA Department of Neurology set out to solve a problem. Neurology patients who couldn’t get an appointment within a week were coming to the emergency department to be seen sooner. But because they didn’t necessarily have an acute need that required being admitted, it was putting unnecessary burden on the ED. Plus, the inpatient neurology service was being requested to see patients they often didn’t need to see.

“This was happening way too often, and people were complaining,” says neurologist Inna Keselman, MD, PhD. “We said, ‘Let’s do something about it.’”

The right solution needed to take into account the interplay between inpatient neurology, the ED and outpatient clinics. Plus, Dr. Keselman notes, it needed a champion. That person was Melissa Reider-Demer, DNP.

Solving for access

When thinking through how to keep patients with nonemergent issues out of the ED, Dr. Reider-Demer and her team recognized that people with conditions like headaches and seizures were not able to get appointments as quickly as they wanted.

However, the team discovered that a lot of patients canceled appointments, leaving openings in providers’ schedules — but there wasn’t a system for matching those openings with a patient.

That’s where UCLA Fast Neuro came in. The model, developed by Dr. Reider-Demer and the team, created a pool of patients within CareConnect who needed to be seen in the next week or two, whether they were referred from an ED (external or at UCLA) or an internal department.

Then, Dr. Reider-Demer and a coordinator began to scan for provider availability throughout the day, starting with residents, then nurse practitioners and then general neuro attendings. When they found an open slot, they’d match it to a waiting patient.

A win-win from all perspectives

For a simple solution, the results were dramatic. From January 2019 through January 2021, 201 patients were referred to outpatient neurology through UCLA Fast Neuro. Wait time for an appointment was reduced by 82.5% (from more than a month to less than two weeks), and the number of nonemergent consults from the ED was reduced by 60%.

They discovered that not only were they able to get patients in for appointments faster, but there were internal benefits, too. Resident clinics were full, which was great from a teaching perspective. A survey found that 92% of attending physicians and advanced practice providers and 89% of residents felt that seeing the UCLA Fast Neuro patients did not detract from their clinic experience.

“The residents really liked it because oftentimes there were very interesting cases,” Dr. Reider-Demer says. “They got to see the onset of a case instead of just inheriting follow-up.”

Importantly, the solution was not time-intensive and didn’t require hiring new personnel. It took Dr. Reider-Demer and a coordinator only about 15 to 20 minutes a day to implement the new model. They also saved time by not answering as many phone calls from patients desperate for an earlier appointment.

The full results from the UCLA Fast Neuro study will be published this month in Neurology Clinical Practice.

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