Team-Based In-Basket Management to Improve Time to Refill in an FQHC-based Family Medicine Residency Clinic

Background: Primary care physicians face increasing electronic medical record (EMR) in-basket workload, particularly for medication refills, which contributes to burnout and delayed care. Primary care residency clinics are especially vulnerable due to frequent resident and staff turnover. Objective: To evaluate the impact of workflow redesign on refill turnaround times and resident confidence with in-basket management in a Federally Qualified Health Center (FQHC) family medicine residency clinic. Methods: A multidisciplinary, resident-led quality improvement project was conducted across three, four-month Plan-Do-Study-Act (PDSA) cycles (June 2023–May 2024). Interventions included implementing a rotating “Desk Doctor” role to manage urgent in-basket tasks and developing standardized Nurse Message Unit (NMU) refill workflows with an Epic EMR smart phrase template. Outcomes included refill turnaround time from Epic Signal Reports, resident confidence with in-basket tasks, and staff satisfaction. Results: Residents reported improved confidence in managing refills after serving as Desk Doctor though the change was not significant and time to refill did not improve. An NMU algorithm and smart phrase intervention decreased time to refill from 7 to 3–4 days, with times rebounding to ~5 days after staff turnover but remaining below baseline. Residents reported that the NMU algorithm wasted less time and improved chart review process for refills. Conclusion: Workflow redesign improved time to refill, improved resident confidence and reduced after-hours burden. Sustainability was challenged by staff turnover, highlighting the importance of cross-training and standardized protocols. These findings demonstrate the value of resident-led quality improvement projects in advancing efficiency, reducing clerical burden, and supporting physician well-being.