‘Go to Green' Campaign Improving Chart Closure Rates at Two Family Medicine Clinics

Provider wellness is a complicated algorithm that is impacted by many things: environment, colleagues, work load, home life, nutrition and sleep. Identifying ways to improve provider wellness can be tricky, as many techniques that might work (see fewer patients, work fewer hours) aren't necessarily compatible with professional success. One approach to improving provider wellness is to focus on getting "work done at work," meaning, don't take work home with you. For family physicians, this often means closing clinic charts the same day they are opened, while you are still in clinic. Within our EHR (Epic) both providers and MA staff play a role in opening and closing the clinic note each day. The dance between what the MA does (or needs to do) and what the provider does (and needs to do) in order to close a chart is complex.

Improving Chart Closure Rates at Two Family Medicine Clinics University of Utah Health Department of Family & Preventive Medicine Erika Sullivan, MD; David Newton, MBA/MHA; Brenda Higgs; Brady Kerr, RN; Rebecca Larsen, RN; Marci Thayne, R; Bernadette Kiraly, MD; Susan Pohl, MD; Charles White, MD PROGRESS TO DATE: Implemented ‘Go to Green' campaign with high adoption from care team. Greatest impact in same-day chart closures seen in providers who had 0-50 or 51-100 charts per month. ROADBLOCKS & BARRIERS: Finding a suitable way to recognize staff that complies with University gift regulations without requiring additional attention to deliver rewards. VALUABLE LESSONS LEARNED: Using existing technologies to enhance communication can improve chart closure rates. Project Insights ‘GO TO GREEN' CAMPAIGN PROJECT VISION Provider wellness is a complicated algorithm that is impacted by many things: environment, colleagues, work load, home life, nutrition and sleep. Identifying ways to improve provider wellness can be tricky, as many techniques that might work (see fewer patients, work fewer hours) aren't necessarily compatible with professional success. One approach to improving provider wellness is to focus on getting "work done at work," meaning, don't take work home with you. For family physicians, this often means closing clinic charts the same day they are opened, while you are still in clinic. Within our EHR (Epic) both providers and MA staff play a role in opening and closing the clinic note each day. The dance between what the MA does (or needs to do) and what the provider does (and needs to do) in order to close a chart is complex. BASELINE ANALYSIS & INVESTIGATION IMPROVEMENT DESIGN & IMPLEMENTATION When we examined our baseline state we found: • Chart closure requires more than the provider finishing all of the clinical documentation. In many instances the provider is unable to close a chart because important documentation needs to be completed by the MA. However, these steps often require that the provider signs an order first. This cascade of "you do this, so that I can do this" can get backed up if there is not We created a communication channel whereby the MA and provider efficiently and effectively communicate what needs to be done to facilitate chart closure: an efficient way to communicate what needs to be done in real time. When we analyzed the baseline state data we found: • Providers who see the most patients (101 - 150+ charts per month) are the most efficient at baseline at same-day chart closure with rates of 77% at Sugar House and 84% at Madsen. • Providers who closed fewer charts (0 - 50 or 51 - 100 per month) were less efficient at same day chart closure (49% and 65% respectively at Sugar House and 64% and 70% respectively at Madsen) GOALS 1 2 Increase same-day chart closure rates at Sugar House Clinic (SHC) to 80% Increase same-day chart closure rates at Madsen Health Clinic (MHC) to 90% • Providers with 0 - 50 chart per month from baseline 49% SHC, 64% MHC • Providers with 51 - 100 charts per month baseline 65% SHC, 70% MHC • Providers with 101 - 150+ chart per month from baseline 77% SHC, 85% MHC Figure 1 • Utilized existing colored dots system in the schedule tab of EHR (Figures 1 & 2) COLOR DOT LEGEND No show Provider needs MA MA needs provider MA has EVERYTHING done • Pre-visit huddle: Provider-MA pair use a newly designed clinic schedule that facilitates recognition Chart is closed Resident needs Attending Figure 2 of important "to dos" for each patient: Medicare status, MyChart status, depression screening, risk score etc. (Figure 2) To encourage participation in the improved process, we created the ‘Go to Green' campaign which rewarded the top MA's at the monthly Clinical Quality Meetings. RESULTS Same Day Closures at SHC 1 2 Chart/mo : ▬ 0-50 ▬ 51-100 ▬ 101-150+ 90% 75% 60% 45% Same Day Closures at MHC Total % Change Chart/mo: ▬ 0-50 ▬ 51-100 ▬ 101-150+ MHC 101 - 150 MHC 51 - 100 90% 77 81 76 65 67 85 76 66 62 49 Baseline 75% 60% 70 64 77 75 83 80 67 17-Sep SHC 101 - 150 SHC 51 - 100 SHC 0 - 50 SHC 56 MHC 45% 17-Aug MHC 0 - 50 Baseline 17-Aug 17-Sep -5% 0% 5% 10% 15% 20% 25% RESILIENCY CENTER | DEPARTMENT OF FAMILY & PREVENTIVE MEDICINE