New Initiative Aims to Reduce Clinician Burnout

Could a new type of visit cut down on time providers spend in MyChart?

When pediatric gastroenterologist Laura Quinn, MD, began her role at Children’s Hospital Colorado, she noticed a concerning trend. Many of her colleagues were spending hours after work every day answering patients' questions through the online patient portal, MyChart. This type of work was so commonly done in the evening that it got the nickname, “pajama time.” A new initiative — aptly named the Pajama Project — aims to change that.

With funding from a wellness grant, Dr. Quinn implemented the four-month pilot program, which expanded on work developed by Kerry Reed, NP, a pediatric gastroenterology nurse practitioner at Children’s Colorado.

The Pajama Project updates the process of follow-up care for gastroenterology patients. Prior to this program, patients would send questions, concerns or updates through MyChart. If a nurse couldn’t answer their questions, the request was sent to providers. Depending on their practice style, they’d message back and forth, and conversations from Dr. Quinn’s end would begin to look a little like this:

“Tell me a little bit more.”

"Have you tried this?”

“Why don’t you try this.”

The back-and-forth could become cumbersome, adding additional strain on the providers, and also could contribute to medical errors.

“The likelihood that you’re getting a complete story and providing the soundest advice is lower when you’re not communicating in real time,” Dr. Quinn explains.

If the provider determined another visit was needed, they’d either try to squeeze the patient into a busy schedule, sometimes double-booking patients, or set them up with the next available appointment, which could cause a delay in care.

The Pajama Project creates a new type of visit in a space that’s already available in a provider’s schedule. The new workflow allows nurses to schedule into provider’s calendars.

“It creates a visit that’s already available, ready for that specific purpose,” Dr. Quinn says. “Nurses can fit that patient with unexpected issues into a visit that same week or the following week. That’s really what this project was focused on.”

After the four-month program, Dr. Quinn surveyed the providers and nurses about work-related satisfaction, time spent in electronic medical records and more. Providers said they enjoyed having the spots available and directly saw the benefits of making medical decisions during an in-person visit versus in MyChart. Doctors said that this all led to an increase in job-related satisfaction, and nurses reported that they also enjoyed the program. Many found relief in the decrease of MyChart messages and felt empowered by their new scheduling capabilities.

“What I heard from my colleagues is that they love the work they do and helping address these concerns is really impactful in keeping people satisfied in what can be a challenging job,” Dr. Quinn says.

The new workflow and visit types benefit the patients too. Anecdotally, Dr. Quinn has heard that families appreciate being seen in a timely fashion. The process is continuing to evolve, and Dr. Quinn believes they’re heading in the right direction.

“Now our focus is on expanding this program more broadly among the gastroenterologists here in Aurora and in Colorado Springs. Other divisions at Children’s Colorado are also interested in giving this a try, which has been exciting. I’m hopeful this will make work and life a little easier for both providers and patients,” Dr. Quinn says.