Formula for surgical practice resuscitation in an academic medical center

BACKGROUND: Managing patient referrals for surgical consultation in an acad emic practice has traditionally emphasized clinical rather than service exp ertise. However, assuring both efficiency and accuracy in the initial consu ltation have become critical early measures of quality care. METHODS: In partnership with the academic medical center administration, cu rrent practice was analyzed. Performance and communication standards were e stablished around an ideal patient experience. A new ambulatory consultatio n process was developed; and flowcharting methods for resource allocation, statistical process control, and pre-visit data collection were used to red uce patient administrative time. Automated referral reports engaged referri ng physicians throughout the consultation, RESULTS: Accurate insurance and referral authorization have been provided f or all patients, including the 4% who are underinsured. Patient, provider, and referring physician satisfaction has increased significantly. Staff tim e investment has progressively declined from 52 +/- 11 (95% confidence) min utes to 34 +/- 10 minutes for most patients. Realignment of tasks has reduc ed the administrative time spent by the patient by 32% without compromising clinical time. New patient volume increased by 29% per year, maintaining r egional market share. CONCLUSIONS: Expertise in the process of consultation delivery is feasible and will be increasingly critical to the survival of academic surgical prac tice in a competitive market. (C) 2000 by Excerpta Medica, Inc.