Michelle Ellis, MD, and her team at Prairie Lake Family Medicine in Lincoln, NE, focuses on pre-visit planning as a strategy to improve efficiency and patient care.
The trigger for this approach was the implementation of a system-wide, patient-centered medical home transformation that began two years prior. This organizational change required more preparation before each visit and advance planning of preventive care needs, which contributed to more work for the clinical team.
The team preps for scheduled visits one day in advance; patients who have scheduled an appointment for the same day are prepped prior to Dr. Ellis entering the exam room. The two nurses who support Dr. Ellis are the primary team members responsible for prepping the charts and each have specific responsibilities. One nurse prepares for mammograms, DEXA, and colonoscopies while the other nurse preps for needed vaccines, pulmonary function testing, preoperative EKGs, follow-up imaging, and Pap smears. All clinical updates are documented on the care team's huddle prep sheet and reported to Dr. Ellis. This “divide and conquer” approach ensures that Dr. Ellis's thoughts and priorities for each visit are organized and she is able to get the most out of each patient encounter as efficiently as possible.
Pre-visit planning can also have its challenges. Finding the right ratio of staff to patients to accommodate this new workflow has been an ongoing process. Dr. Ellis works with two nurses and shares a scheduler, a front office staff member, and a lab technician with her office partner. In addition, she shares two part-time team members with other offices and administration, one who helps with referral coordination and one who provides health coaching. Each team member is cross-trained and can cover for each other and perform additional duties as required. Strong team communication is also essential.
To create the best patient experience possible, Dr. Ellis, her partner, and their teams frequently evaluate and make small changes to any new process or procedure they are trying out. They learn what's working and what can be done more efficiently through open dialogue in team meetings. They plan to use patient satisfaction surveys to measure the impact of their new workflows and continue augmenting the processes until they are fully optimized.
As a result of pre-visit planning, the practice is able to provide more preventive services, such as pap smears, mammograms, immunizations, colonoscopies, and bone density scans while improving outcomes for patients.