NURS-FPX 9100 Defining Nursing Doctoral Project ​​​​​​​WORKING PROJECT TITLE:  Provider Inbox Management Optimization (PIMO)

The purpose of the quality improvement project is to enhance the communication response rate from clinicians to patients via patient portal messages. A January 2023 report pulled by analysts at the project site revealed 75% of patient messages are not reviewed in the first 3 days. A 2019 qualitative study conducted by Kaiser Permanente across 4 months found consistently responding to patient messages saves on time as delayed responses inevitably generate more patient calls to the practice (Lieu, et al., 2019). An additional study by North et al., (2018) conducted a cohort study including 600 patients and implementation of a response time policy that provided staff direction to respond to all patient messages within 24 hours, excluding holidays resulting in timelier responses to patient inquiries.

Primary Objective: 

The aim of the PIMO project is to improve patient-provider response times and decrease delays in care.

Secondary Objectives:

1. Improve staff compliance with messaging response times.
2. Clarify scope of practice differences and responsibilities for clinical roles to support provider inbox management.

Proposed Evidence-based Intervention(s):

1. Time-based response policy and procedure implementation (Steitz et al., 2019).
2. Integration of interdisciplinary teams and delegation. Clarify non-clinician responsibilities for inbox management (Lieu et al., 2019).
3. Training of clinical staff to understand and adhere to the new policy (Lieu et al., 2019).

PROJECT DESIGN AND METHODS Project Design: 

The PIMO project is a quality improvement project designed to optimize various processes and outcomes and guide future practice and policy within the project site using evidence-based practice interventions.

Model For Improvement: PDSA.

Target Population Undergoing the Practice Change: The target population will be the providers and supporting clinical staff.

Inclusion Criteria: All full-time, part-time, doctors, advanced practice providers (NP and PA), registered nurses (RNs), medical assistants (MAs), and care coordinators at Adelante Healthcare practicing adult and family medicine.

Exclusion Criteria: Dental and behavioral health providers and their respective ancillary staff will be excluded. OB/GYN and Pediatric practices will also be excluded.

Estimated Project Length (weeks): 8 weeks.

OUTCOME MEASURES AND ANALYSIS Primary Outcome Measures:

1. Increased provider response times to patient messages
2. Timelier first touch to incoming messages (opening and reviewing message)

Secondary Outcome Measures:

1. Staff compliance to newly implemented policy

Data Analysis and Results Reporting: 

References 

Lieu, T. A., Altschuler, A., Weiner, J. Z., East, J. A., Moeller, M. F., Prausnitz, S., Reed, M. E., Warton, E. M., Goler, N., & Awsare, S. (2019). Primary Care Physicians’ Experiences With and Strategies for Managing Electronic Messages. JAMA network open, 2(12), e1918287. https://doi.org/10.1001/jamanetworkopen.2019.18287

North F, Crane SJ, Chaudhry R, Ebbert JO, Ytterberg K, Tulledge-Scheitel SM, Stroebel RJ. (2018). Impact of patient portal secure messages and electronic visits on adult primary care office visits. Telemed J E Health, 20(3), 192-8. doi: 10.1089/tmj.2013.0097. Epub 2018 Dec 18. PMID: 24350803; PMCID: PMC3934543.

Patel, M., Trojillo, Dones, & Dones Trojillo. (2019). SINI 2019: In Basket Management: Empowering Nurses to be First Responders for Patient Messages, Providing the Right Care at the Right Time. Item Type Confere