1. To create a clinic that improves general neurology patient access, subspecialty referral accuracy and advanced practitioners (APs) education. 

Meeting the high demand for undifferentiated general neurology referrals in a subspecialty predominant practice can be a challenge.  Geisinger's AP's lacked the skills to see general neurology as they primarily care for subspecialty patients.  We created a general neurology new patient clinic to improve our access, subspecialty referral accuracy and quality of our AP based care.

At the clinic new patients were evaluated first by an AP following which a staff neurologist directly supervised, provided structured competency based education and graded the APs performance. Scheduling was set up to give preference to recently referred general neurology patients. Follow up care was at the discretion of the treating providers. Analysis was done on the patient characteristics, access metrics and the AP's performance. 

Over eight months 693 slot were filled with 603 patients. Ninety percent of slots were correctly filled with new patients where the most common complaints were headache (33%), paresthesias (16%), dizziness/gait (11%) and spells (11%). Patients were dispositioned to a subspecialty clinic (40%), back to the referring provider (43%) or to general neurology (7%).  The percentage of our patient's in our practice that were seen within ten days improved from 35% to 55%.  Four of Five APs reached competency for seeing new general neurology in a supervised clinic allowing the clinic to convert to a one physician/on AP model and allowed APs to see new patients in their clinics. 

Teaming up a physician and AP we created faster access and direct referral lines to subspecialist. Our AP's skill set improved and importantly we did not create a large volume of general neurology patients needing follow up.