Background: Due to the COVID-19 pandemic, all out-patients clinics shifted to telehealth visits. Due to unavailability of the clinics slots the urgent referrals were overbooked as telehealth visits then re-booked by the attending to come in-person for physical evaluation if needed. Our aim of this improvement is to decrease the re-booking of urgent referrals for in-person visits in the general paediatric and the newly opened urgent clinics from 60% to 30%. 

Methods: A cross-sectional intervention study started in October 2020-present at the out-patients general paediatric clinics, HMC, Qatar. The intervention was divided into phases(figure-1). Triaging team contacted the patients and confirms the date & times of the visits. Result: 769 of urgent referral screened over 2-years. Urgent referral seen in clinics were 538(70%) and rebooked referral 231(30%). In phase1 intervention-1 rebooking of urgent referral decreased from 61% to 48% over 1 month and decrease further in intervention-2 to 23%. At phase-2 the rebooking had decreased further to 12% after starting of the urgent clinics. However it start to increase as of the 2nd wave of COVID-19 with peak at May 2021 reaching 57%. In phase-2 intervention-1 the rebooked urgent referral decrease to 8% only. It was noticed increase in the rebooking reach up to 25% in January 2022 in mostly Sunday afternoon urgent clinics which improved to 12% in February after changing the clinics time to morning clinics. Conclusion: Standardization reduces wastes in processes and decreases variations that may lead to overutilization of our limited resources and negatively affects patient care. By using a standardized pathway and introduce a newly urgent clinics program the aim was achieved to decrease re-booking of urgent referral for in-person evaluations. Continuous monitoring and evaluation of the outpatient referrals processes are critical in ensuring delivering high-quality care especially at the time of pandemics.

TBA