Todd E. Johnson, DO, and his team at Autumn Ridge Family Medicine in Lincoln, NE, has used pre-visit planning for years. Initially, an informal process was developed by a desire to be prepared for the upcoming clinic day. As the team began to investigate the criteria for certification as a patient-centered medical home, they began to organize their informal process into a standardized checklist within the electronic health record (EHR). This new checklist had a dramatic effect on the flow of their day.
The checklist includes:
How many patients were seen the previous day.
How many patients were sent to an urgent care center or the emergency room.
How many openings there are in the schedule and at what times.
The third next available chronic visit, acute visit, or wellness exam.
The team continued to formalize their pre-visit planning activities by adding reminders for overdue labs and orders into the EHR. The team scheduler's role expanded to include reminding patients about lab tests when she called to confirm their appointments. The scheduler relies on standing orders and written protocols to know which tests to discuss with patients.
In addition, new nurses were trained to fulfill standing orders as part of the pre-visit planning process. Every person on the team now plays a role in pre-visit planning in some capacity, leading to one hour saved over the course of a clinic day.
Every day, Dr. Johnson's team attends a pre-clinic huddle. The team scheduler kicks off the huddle with a summary of the previous day's work, followed by an overview of the upcoming day's schedule and caseload. This overview includes openings in the schedule and which team members are out for the day.
Dr. Johnson's nurse then takes over and discusses the details of the day's more complex patients. She focuses on addressing any gaps in care identified by the practice reminder system for patients with asthma, chronic obstructive pulmonary disease, hypertension, and/or diabetes. Reminders are set for items such as pre-visit labs, immunizations, and diabetic eye exams. All other tasks needing attention are covered by others on the team. By the end of the huddle, there is a clear understanding of the plan for the upcoming day.
Dr. Johnson's team measures their success based on no-show rates, which have dropped dramatically since they formalized their pre-visit planning process. In fact, Dr. Johnson and his team now have one of the lowest no-show rates in the network.
“I can't imagine not doing pre-visit planning. Everyone's contributions make things run so smoothly that when someone is missing from the huddle, it results in a chaotic day,” said Dr. Johnson. “Pre-visit planning changed the energy in the office and made this a better place to work.”
The other two physicians in the clinic with Dr. Johnson use their own unique versions of pre-visit planning with their teams. Like Dr. Johnson, they recognize the benefits of pre-visit planning, but have found that there is no one-size-fits-all approach to preparing for the day.
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