Impact of teamwork in low medical density areas: an outpatient study

Introduction The initial and rapid diagnosis of cardiac pathologies such as coronary heart disease and heart failure relies heavily on the availability of outpatient cardiology facilities. Growing difficulties in accessing care may lead to an increased burden of heart disease and mortality, particularly in remote rural areas. Objective Our objective was to evaluate the impact of a new organization of teamwork, in outpatient settings, on the efficiency of medical time and access to cardiology care. Method The new Point Of Care in Cardiology (POCC - Figure 1) teamwork organization is based on 3 pillars: (1) advanced practice nurse (APN), (2) sonographer and (3) cardiologist. It was applied in one of our rural outpatient centers. To estimate medical time efficiency, we calculated the access to care index (ACI) as the ratio of the number of new patients over a day (8 hours) of cardiologist medical time. We also assessed patient satisfaction using a standard score from 1 (low) to 5 (high) (by answering the question: "How would you rate your satisfaction with the consultation process in our center?"). Results Over a period of 19 months (June 2023 – December 2024), 3366 patients had one or more consultations and medical examinations in our center. During this period, 130 days of cardiologist medical time were available (1.6 days/week). The ACI over this period was 25.9 patients/day. The number of echocardiograms was 3060. The APN carried out 3798 consultations. For patient satisfaction, a total number of 2448 responses were collected with an average satisfaction score of 4.75 (96.2% of patients rated 4 or 5) Conclusion Implementing the POCC teamwork process was easy. It has shown a high level of efficiency in access to care and patient satisfaction, despite the scarcity of cardiologists. Organizational innovation seems very promising in providing a solution to the shortage of medical services.