83 - Team PRONTO: How a Multi-System Pediatric Navigation Program Improved Patient Subspecialty Access After the Closure of Inpatient Pediatrics at an Academic Medical Center.

Publication Number: 4081.83

Geoffrey G. Binney, Tufts Medical Center, Boston, MA, United States; Megan Z. Cardoso, Tufts Medicine Integrated Network, Dunstable, MA, United States; Sarah Moore, Tufts Childrens Hospital, Swampscott, MA, United States

Background: In July 2022, an academic tertiary care medical center (Site 1), which served as the primary referral center for a large referring provider network (RPN) , closed all inpatient pediatric units (excluding the NICU). Although plans to maintain all subspecialties on an outpatient basis were initially made, several departments subsequently closed due to provider attrition. A collaboration with a neighboring children's hospital (Site 2) was established to provide inpatient neonatal care and support pediatric subspecialty outpatient care. Given the frequent changes, the RPN was unable to keep track of available services at Site 1. Multiple interventions including meetings, newsletters, town halls, special phone lines, and website information were made, yet referrals to Site 1 continued to decline.

Objective: To develop Team PRONTO: a nurse navigation-led centralized subspecialty referral program serving 2 hospital systems for a RPN including 60,000 pediatric patients. To improve the patient retention of patients with Site 1 subspecialists. To expedite referral to Site 2 when subspecialist services are unavailable at Site 1.

Design/Methods: In October 2023, an interdisciplinary team consisting of administrators, referring PCPs, and subspecialists created Team PRONTO. A standardized PCP referral process was created. Referral subspecialty pathways and relationships were created with Site 1 and Site 2. Nurse navigators received referrals, assessed acuity, booked subspecialty appointments based on an algorithm, and completed closed-loop communication back to patients and PCPs. Team PRONTO was piloted with 7 referring practices then expanded to entire RPN after 3 months.

Results: Team PRONTO has received 4054 referrals and made 3813 appointments for 19 unique pediatric subspecialties to date. From Year 1 to Year 2, the number of total referrals increased slightly (n=1877 to n=2177), and overall referral volume to Site 1 increased from 63% to 71%. The days between referral and appointment decreased by 15 days at Site 1 and 7 days at Site 2 from Year 1 to Year 2.

Conclusion(s): Pediatric Navigation programs can help improve subspecialty access across multiple hospitals and referral networks. A centralized navigation team can decrease PCP administrative burden. Even with a hospital and subspecialty closures, a centralized navigation team can significantly decrease appointment wait times. Next steps include EMR optimization and the inclusion of local subspecialists.

Referral and Appointment Volume
The volume of referrals and disposition is shown by year. Columns represent the referrals and appointments made at Site 1, Site 2, or made elsewhere or not resulting in an appointment.

Average Time to Appointment
The average time in days between referral to PROTO and date of appointment is shown by year. The columns represent the average days to appointment made at Site 1 or Site 2.