In the 14 years Manisha Jain, MD, has been an obstetrician and gynecologist at the NYC Health + Hospitals/Lincoln Women’s Health Center, one frustrating but unavoidable fact was the significant amount of time patients’ first pregnancy evaluation visits would take out of their day.
Seen by a social worker, nutritionist, nurse, and doctor in that first visit, the patient often spent two hours getting through the appointment’s long checklist.
That was until Dr. Jain, a fellow in United Hospital Fund and Greater New York Hospital Association’s Clinical Quality Fellowship Program, was inspired to find a solution.
“I could witness it, I could complain about it, but CQFP taught me that, ‘Yes, you can be the changemaker,’” Dr. Jain said. “CQFP gave me a platform to do something about it."
Her first time leading a quality improvement initiative, Dr. Jain decided to tackle the long appointment times as her capstone project for the fellowship program.
It didn’t take long to discover a timely remedy: telehealth. Despite other departments at Lincoln Hospital implementing telehealth options since the pandemic, the Women’s Health Center had found it difficult to adapt the video options to their specialty, much of which requires an in-person exam.
But Dr. Jain saw an opportunity with the first-time patient visits. She decided to help shorten in-person visits by transferring the nurse, social worker, and nutritionist screenings—each of which were purely educational—to a virtual visit. The virtual appointment would be completed in the days before the in-person clinician examination, meaning patients had the flexibility to complete them at home, school, or work, instead of spending two hours in the office.
“Our patients are mothers, sisters, and most of their families are run by women—we all agree patients have other things to do in their life, and we cannot assume when they come into the clinic we can take as much time as possible,” Dr. Jain said. “We view our patients’ time as being very valuable.”
To make the shift, Dr. Jain worked on setting up the office to accommodate virtual appointments, including adding cameras to each of the clinic computers and creating a designated area where nurses could take the calls with privacy. The social workers and nutritionists each already had their own room to use for the telehealth calls.
The virtual visits quickly helped bring the in-person exam times down. Soon, the average length for an in-person appointment for Dr. Jain’s new patients dropped from an average of 146 minutes to 90 minutes a visit.
That number ticked up slightly when expanding the telehealth approach to the dozen or so other providers at the Women’s Health Center, whose collective average is 105 minutes per visit. But overall, Dr. Jain is happy to have saved patients around 40 minutes, a 28 percent drop in appointment time.
The patients, around 30 to 40 each month, have also been appreciative.
“They have only good things to say,” said Dr. Jain, who used a survey to evaluate the success of the virtual appointments. “Patients said, ‘If I don't have to sit here in the clinic and I can do this from wherever I am, I'm happy.’”
The change has also set up the Women’s Health Center to find even more efficiencies. Now armed with the infrastructure to accommodate telehealth, Dr. Jain said staff are considering expanding the telehealth approach to educational components of contraception counseling and third trimester appointments.
Plus, the project and the Clinical Quality Fellowship Program have influenced Dr. Jain’s personal quality improvement perspective.
“It changes the way you think about health care,” she said. “Every patient that I see, I think about improvement—not just solving that particular problem for that particular patient that particular day, but how can we change things for everybody?”
Started in 2009, the Clinical Quality Fellowship Program has trained more than 300 mid-career physicians, nurses, and physician assistants from over 50 health care facilities in the New York metropolitan area to become quality improvement and patient safety leaders in their organizations. The 15-month program graduates a new class of these change-makers on the front lines of health care each year.