How Will This Toolkit Help Me?
Learning Objectives
Identify the benefits of implementing pre-visit planning
Describe pre-visit team-based workflows
Employ pre-visit planning tools and templates
Quiz Ref IDPre-visit planning is a team-based approach to planning for patient appointments. Using pre-visit planning, at the end of the current visit:
Patients are scheduled for follow-up appointments
Pre-visit lab testing and other diagnostics are arranged
Necessary information for upcoming visits is gathered
The care team spends a few minutes to huddle and hand off patients between team members
Pre-visit planning communicates to patients that the practice is planning ahead in order to make their next visit as meaningful and productive as possible. Pre-visit planning saves time, reduces practice costs, and improves patient care, and can mean the difference between a clinic where physicians and team members are floundering and frustrated versus one where things run smoothly with the capacity to handle any unanticipated issues that arise.1- 4
Eight STEPS to Implement Pre-Visit Planning
At the End of the Current Visit
Use a Visit Planner Checklist to Preorder Labs and Other Needed Tests for the Next Visit
Schedule the Next Follow-Up Appointment
Arrange for Tests to Be Completed Before the Next Visit
Between the Current and Next Visit
On the Morning of the Next Visit
6. Hold a Pre-Clinic Care Team Huddle
7. Use a Pre-Appointment Questionnaire to Gather Patient Updates
8. Perform a Handoff of the Patient to the Physician
At the End of the Current Visit
STEP 1 Use a Visit Planner Checklist to Preorder Labs and Other Needed Tests for the Next Visit
A medical assistant (MA) or another team member who can schedule the appointments and tests indicated by the physician can use the visit planner checklist. Using a visit planner checklist allows the physician to indicate when the next follow-up appointment should be and any associated labs or other diagnostic tests required prior to the next visit. It should be quick and convenient to use, requiring no more than a few seconds of physician time.
Visit Planner Checklist: Order Sheet for Patient Visits (49 KB)
For example, consider a patient with diabetes, hypertension, and hypothyroidism who will be due for their annual checkup in 3 months. During the current visit, the physician uses the visit planner checklist and indicates the appointment interval by typing “3-month follow up with annual checkup” then also checks “A1c, TSH, Na, K, creatinine, and mammogram.” A member of the physician's team can then schedule the upcoming annual visit, enter orders for the indicated laboratory tests, and provide the patient with instructions on how to schedule the lab tests and mammogram.
STEP 2 Schedule the Next Follow-Up Appointment
Practices can plan ahead by scheduling patients for their next visit at the conclusion of their current visit, including scheduling any needed pre-visit laboratory testing. This saves time and reduces the number of “touches” to set up routine follow-up appointments.
Alternatively, practices that do not have the capacity to hold future laboratory orders may choose to have a team member order labs according to an established protocol based on the patient's medications and/or conditions a few days before the next appointment. Although having a team member order the labs a few days before the appointment involves more touches than scheduling at the time of the current visit, any amount of pre-visit planning is helpful.
As you consider how to implement pre-visit planning in your practice, you can use this checklist to guide you.
Pre-Visit Planning: Implementation Checklist (49 KB)

“We think about the patient more inclusively before they come in for their visit so that we can take care of as much as possible at the time of the visit. This prevents work later.”
—Amy Haupert, MD; Family Medicine, Allina Medical Clinic
STEP 3 Arrange for Tests to Be Completed Before the Next Visit
It is ideal to schedule any pre-visit labs and other diagnostics ordered for the next visit at the end of the current visit to ensure that everything is scheduled as ordered and prevent slots from being filled up if these tests are scheduled too late. The care team can either schedule these directly for the patient during check out (eg, a bloodwork appointment) or give the patient clear instructions on how to schedule themselves (eg, the phone number for mammogram scheduling).
Some organizations arrange for the patient to come in for lab testing a few days before the visit. However, others have developed rapid turnaround or point-of-care testing for most tests to be performed the same day as the visit with the physician. Quiz Ref IDAs a result, both the patient and the practice save time as the practice no longer needs to spend time contacting the patient with results after the visit. Regardless of the approach, the goal is to have the test results available so physicians and patients can discuss the results and make management decisions together during the face-to-face visit.

“An internal medicine practice in Boston found that pre-visit laboratory testing reduced the number of letters and phone calls for results by more than 80% and saved $25 per visit in physician and staff time.”
—J. Benjamin Crocker, MD; Internal Medicine, Ambulatory Practice of the Future, Boston, MA
Between the Current and Next Visit
STEP 4 Use a Checklist to Review Pre-Visit Tasks
Quiz Ref IDA nurse or medical assistant can do visit preparations a day to a week before the appointment. The nurse or medical assistant can conduct the following activities:
Review the physician's notes from the patient's last visit as well as notes from other clinicians who delivered interval care. If any interval care notes or results are not in the patient's record, the nurse or medical assistant can contact that office or department to obtain the information prior to the visit.
Ensure that the patient completed all pre-ordered laboratory tests. If not, the nurse or MA can call the patient to remind them to go to the lab before the upcoming visit.
Identify other gaps in care, such as missing immunizations or cancer screenings. A health maintenance checklist in the EHR or separate registry provides an overview of preventive and chronic care needs. Below is a sample health maintenance checklist that your practice can customize to its needs.
Health Maintenance Checklist (50 KB)
STEP 5 Send Patient Appointment Reminders
Many practices send patients automated reminder emails, phone calls, or text messages a few days before their appointments, reducing no-show rates. If no automated option exists, team members can make these calls or send letters directly from the office. If time and resources do not allow all patients to be contacted prior to their appointment, review the schedule 2 to 3 days prior to clinic, and contact those patients with higher acuity medical needs or known social needs such as transportation insecurity.
Quiz Ref IDIn some practices, nurses or medical assistants also make a pre-visit phone call to their patients with more complex care needs, performing tasks such as medication reconciliation and agenda setting on the phone, and then pre-populating the next day's visit note with this information. Other practices email a link for the patient to complete a pre-appointment questionnaire, and the patient's responses flow into the next day's visit note. Both approaches save the team and physician time during the clinic session.
On the Morning of the Next Visit
STEP 6 Hold a Pre-Clinic Care Team Huddle
A 5- to 15-minute daily pre-clinic huddle brings the team together to review and share knowledge about the day ahead. The care team can use this time to announce last-minute staffing or schedule changes, discuss any particular patient or team member needs, and determine how best to share the workload.
During the huddle, the nurse or medical assistant who performed the pre-visit prep (STEP 4) can tell the physician about an abnormal x-ray result, a complex multi-disciplinary situation, or arrange for an interpreter. The huddle provides an opportunity for the physician to consult with colleagues or other resources before the patient's visit.
STEP 7 Use a Pre-Appointment Questionnaire to Gather Patient Updates
Provide a questionnaire to every patient electronically from home or on paper at check-in to complete before the appointment. The pre-appointment questionnaire allows the team to see what is most important to the patient and helps the physician plan the visit before entering the room. The pre-appointment questionnaire can include questions that would otherwise be asked during rooming, such as depression screens, pain assessment, smoking status, falls screening, and specific questions associated with the Medicare Annual Wellness Visit.
Pre-Visit Questionnaire (53 KB)
The patient can review and edit a printed medication list in the waiting room. Patients can highlight which medications need refills or which medications they are not taking. By shifting these questions to the questionnaire, the nurses and medical assistants have much of the information they need to obtain during the visit, giving them more time to engage with patients.
STEP 8 Perform a Handoff of the Patient to the Physician
The nurse or medical assistant will often learn important information about the patient during the rooming process. A brief 1-minute handoff to the physician can save time in the exam room by helping the physician focus the appointment to meet the patient's needs and expectations. The handoff also makes patients aware that their care team works together on their behalf. For example, the physician may say, “The nurse mentioned that you've been worried about side effects from your cholesterol medication—please tell me more.” The team will quickly see the importance of their initial discussions with patients.
Quiz Ref IDThe strategies, tools, and resources in this toolkit can assist you in adopting a pre-visit planning approach that fits your practice's specific needs. With pre-visit planning, your practice can benefit from improved communication with patients, streamlined scheduling of appointments, and enhanced care team efficiency during all patient visits.
You can measure the impact of pre-visit planning using this pre-visit planning measurement guidebook. It is designed with a quality improvement framework that will allow you to see positive changes in your operational efficiency.
Measure the Impact of Pre-Visit Planning (97 KB)
Journal Articles and Other Publications
Jerzak J, Siddiqui G, Sinsky CA. Advanced team-based care: How we made it work. J Fam Pract. 2019;68(7):E1-E8. https://www.mdedge.com/familymedicine/article/207667/practice-management/advanced-team-based-care-how-we-made-it-work
Sinsky CA, Bodenheimer T. Powering-up primary care teams: advanced team care with in-room support. Ann Fam Med. 2019;17(4):367-371. doi:10.1370/afm.2422
Day J, Scammon DL, Kim J, et al. Quality, satisfaction, and financial efficiency associated with elements of primary care practice transformation: preliminary findings. Ann Fam Med. 2013;11 Suppl 1(Suppl 1):S50-S59. doi:10.1370/afm.1475
Crocker B, Lewandrowski EL, Lewandrowski N, Gregory K, Lewandrowski K. Patient satisfaction with point-of-care laboratory testing: report of a quality improvement program in an ambulatory practice of an academic medical center. Clin Chim Acta. 2013;424:8-11. doi: 10.1016/j.cca.2013.04.025
Crocker JB, Lee-Lewandrowski E, Lewandrowski N, Baron J, Gregory K, Lewandrowski K. Implementation of point-of-care testing in an ambulatory practice of an academic medical center. Am J Clin Pathol. 2014;142(5):640-646. doi:10.1309/AJCPYK1KV2KBCDDL
Shafer R, Kearns C, Carney M, Sagar A. Leveraging interdisciplinary teams for pre-visit planning to improve pneumococcal immunization rates among internal medicine subspecialty practices. J Prim Care Community Health. 2021;12:21501319211060986. doi:10.1177/21501319211060986
Hickey MD, Sergi F, Zhang K, et al. Pragmatic randomized trial of a pre-visit intervention to improve the quality of telemedicine visits for vulnerable patients living with HIV. J Telemed Telecare. 2020;1357633X20976036. doi:10.1177/1357633X20976036
Magnan E, Gosdin M, Tancredi D, Jerant A. Pilot randomized controlled trial Protocol: Life context-informed pre-visit planning to improve care plans for primary care patients with multiple chronic conditions including diabetes. J Comorb. 2021;11:26335565211062387. doi:10.1177/26335565211062387