Clinic redesign increases efficiency and teamwork, shortens patient wait time

Dec. 21, 2019

Abnormal uterine bleeding (AUB) is a common concern among women throughout their lives. Prior to the launch of a new collaborative clinic in 2015, women's health nurse practitioners (WHNPs) and gynecologists at Mayo Clinic in Rochester, Minnesota, were seeing patients with AUB separately. Often, it was recommended for patients to return for a hysteroscopy, a diagnostic tool to evaluate AUB, after their initial evaluation visits — scheduled as much as six weeks later.

Besides causing patient dissatisfaction, scheduling multiple appointments and waiting for a hysteroscopy could also lead to delayed diagnosis and management. Furthermore, because nursing staff often reviewed patient records for both the WHNP and gynecologist visits, which were at times duplicative, nurses' workloads were negatively affected.

"We realized there was a lack of efficiency, which was contrasted with limited time for some procedures. Patients were scheduled for hysteroscopy procedures when they were not needed," says Shannon K. Laughlin-Tommaso, M.D., with Gynecology at Mayo Clinic in Rochester, Minnesota. "These patients could have been better suited to an earlier appointment with a women's health nurse practitioner."

To improve the management of patients with AUB and the use of hysteroscopy in a general gynecology practice setting, a collaborative hysteroscopy clinic was developed and launched in August 2015. This collaborative team model includes consecutive visits with nurse practitioners and gynecologists: Each patient with AUB is first evaluated by a nurse practitioner and then immediately afterward has a shorter visit with a gynecologist for an in-clinic hysteroscopy.

Clinic improves scheduling and efficiency

To measure the changes in patient satisfaction, Dr. Laughlin-Tommaso and a team of researchers conducted a retrospective review of the data collected before and after the launch of the collaborative clinic. Study results were published in the Journal of the American Association of Nurse Practitioners in 2019.

"Based on baseline data, our target goal was for at least 50% of hysteroscopy appointments to be scheduled within two weeks of the initial call to the department or referral from the provider," says Dr. Laughlin-Tommaso. "We also wanted to improve overall efficiency and streamline the process for evaluating patients with AUB.

"To optimize logistical planning for hysteroscopy, a process was created for a preclinic huddle involving the assigned collaborative hysteroscopy clinic participants, including a minimally invasive gynecologic surgeon, two WHNPs and the nursing staff. Huddles allow the team to discuss the patient's pertinent medical history and available imaging related to the bleeding concern to help determine the utility of a hysteroscopy."

Clinical assistants have since been included in the workflow at the collaborative hysteroscopy clinic. They help patients in completing a standardized bleeding questionnaire before their visits with the WHNP, a job formerly performed by nursing staff. "This change has allowed nurses to have an improved workflow and empowered clinical assistants to work to the top of their scope of practice, further enhancing the teamwork of the multidisciplinary team," says Dr. Laughlin-Tommaso.

After launching the collaborative hysteroscopy clinic:

  • 63% of patients were scheduled within zero to 13 days of initial contact, compared with 30% before creation of the clinic
  • There was a significant decrease in the number of patients scheduled 28 days or more after initial referral: 51% before intervention, 15% after intervention
  • Appointment slots increased from 423 to 735
  • The total number of patients seen for hysteroscopies increased from 393 to 647

"The collaborative model resulted in improved scheduling and efficiency of clinic visits," says Dr. Laughlin-Tommaso. "Providers, nurses, clinical assistants and appointment coordinators have all expressed satisfaction with the intervention, citing better workflow and inclusion on the team."

The collaborative hysteroscopy clinic operates several half days each week. Each clinic is staffed by two WHNPs and one surgeon trained in minimally invasive gynecological surgery. Each WHNP has openings for three patients with AUB (six patients total per half day), while surgeons have time allotted to perform a hysteroscopy on all six patients if necessary.

For more information

Wygant JN, et al. Improving patient access through office hysteroscopy clinic redesign. Journal of the American Association of Nurse Practitioners. In press.