Enhancing Timely Primary Care with a Same-Day Resident in an Academic Clinic

Introduction

To evaluate whether incorporating a dedicated urgent care resident slot into the clinic schedule improves task completion efficiency, same-day appointment availability, and management of truly urgent clinical tasks.

Methods

This quality improvement initiative was conducted in an outpatient primary care clinic. A scheduling intervention was implemented that added a dedicated urgent care resident slot to address urgent tasks and same-day visit needs. Pre-intervention data were collected over 39 clinic days, and post-intervention data were collected over 6 clinic days following implementation. Outcomes measured included tasks completed per clinic day, total urgent tasks, proportion of truly urgent tasks, number of same-day appointments, and patient and provider satisfaction. Descriptive comparisons were performed between pre- and post-intervention periods.

Results

Prior to the intervention, 50 total tasks were completed over 39 clinic days (average of 1.28 tasks/day). Post-intervention, 56 tasks were completed over 6 clinic days (average of 9.3 tasks/day), representing a greater than six-fold increase in tasks completed per clinic day. Truly urgent tasks increased from 13 out of 50 pre-intervention to 19 out of 56 post-intervention. Same-day appointment availability improved from 4 out of 50 pre-intervention to 11 out of 56 post-intervention. Patient and provider satisfaction data collection was incomplete; however, among respondents who were surveyed, 100% reported satisfaction in both pre- and post-intervention periods.

Conclusions

This project was limited by a short post-intervention observation period, incomplete satisfaction data, and confounding factors including initial staff and resident unfamiliarity with task triage workflows. Transition-related constraints within the electronic medical record (Epic) and early misrouting of tasks also impacted implementation.

Introducing a dedicated urgent care resident significantly improved clinic efficiency, urgent task management, and same-day appointment availability. Future efforts will focus on enhanced staff and resident education, improved task triage workflows, and collaboration with information technology to optimize EMR integration. Expanding this model to ensure daily urgent care resident coverage with sufficient patient volume may support development of a formal urgent care rotation and further improve access to timely primary care.