(P98) We Can Do Better! Improving Patient Access to Hematology Care With Advance Practitioners

Paper / Poster Presentation Abstract: Basis of Inquiry:
Our 2023 hematology clinic wait times for new patient appointments were the highest of all the program subspecialties with a peak of 90 days for non-urgent hematology patients. Many patients are referred to hematology for evaluation of iron deficiency anemia (IDA) in toddlerhood with 55% of IDA referrals being non-white. In Minnesota, IDA in toddlerhood has been found to be more prevalent in Hmong populations due to cultural practices; Minnesota has the largest Hmong US populations. Racial and ethnic minority groups are more likely to have limited access to care; they are more likely to have longer wait times for subspecialties. If untreated, IDA can cause symptoms such as fatigue which impact activities of daily living; additionally, in early life it can lead to altered behavior and impact brain development. Moreover, IDA can be a symptom of other underlying health conditions. Therefore, our system change sought to improve access to specialty care for children of diverse populations.

Purpose:
The purpose of this quality improvement project was to improve access to hematology care and reduce patient wait times through advancing the scope of practice of hematology advanced practitioners (APPs) caring for newly referred IDA pediatric patients.

Methods:
At a large cancer and blood disorders program, 3 FTE’s of pediatric hematologists saw approximately 500 new hematology patients per year with over 40% having a referral for IDA. In the hematology program there were 4 APPs including 3 pediatric nurse practitioners and 1 physician assistant. APPs’ schedule openings showed open times that were available sooner than hematologists.

The hematology provider team worked with clinic leadership to develop and implement a plan to improve appointment accessibility for new IDA patients. Hematologists implemented an educational session for APP colleagues that included consulting a hematologist as needed.
New referrals are triaged by a hematologist who determines how quickly patients need to be seen. The open schedule slots for new IDA referrals was changed to include APPs.

A customized tool was developed with an IT analyst to track time in days to new appointments for all new hematology patients; the program director reviews it weekly and trouble shoots barriers to timely appointments.

A standard measure of clinic accessibility is the 3rd next appointment (3NA) available; this measure adjusts for unplanned earlier openings. Our goal was an appointment within 3 weeks of referral. Average 3NA wait times were calculated for the 2 months pre and post project implementation.

Findings/Outcome:
Wait times for all hematology patients decreased from a mean of 47 days to 24 days post implementation. This improvement supports access to care and a timelier treatment of IDA. Hematology APPs saw 88 new patients during the first 6 months of implementation allowing for wait times for all new hematology patients to decrease.

This further demonstrates the capabilities of APPs to provide specialized hematology care and the benefits of investing in APP education. Next steps in program implementation includes educating APPs to perform new referral triage and evaluating clinical outcomes of the patients with IDA.