Like most physicians, Ben Crocker, MD, used to see his patients first and then send them to the lab after their appointments. This system of post-visit lab testing required handling each test result individually as it was released from the lab. Dr Crocker was awash in results as multiple lab results from multiple patients returned to his inbox and were intermingled with other messages. He would try to write a letter to the patient or reach them by phone, but often had to remind himself of the scenario for which the labs were ordered. He realized that it not only required a lot of work for him and his team to sort through and manage the data as it arrived piecemeal, it was also inconvenient for the patient. Post-visit lab testing also prevented Dr Crocker from being able to discuss the test results with the patient at the visit. Due to missed opportunities for important face-to-face counseling to explain results or discuss certain medical conditions, it was common for patients to call back with questions about their results that they did not understand from the letter or phone message.
To address these issues, Dr Crocker and his practice instituted point-of-care pre-visit laboratory testing.
The practice compared the number of follow-up phone calls and letters from before and after implementation. Pre-visit lab testing reduced the number of phone calls to the practice by 89% and reduced the number of letters sent to patients about lab results by 85%. There were significantly fewer revisits due to abnormal tests (61%) and fewer lab tests ordered overall (21%) since the results were reported in real-time. This saved the practice $25 per visit in physician and team time. Importantly, anecdotal evidence suggested that patient satisfaction with their care also increased.
The Ambulatory Practice of the Future (APF) at Massachusetts General Hospital in Boston provides innovative primary care for staff and their spouses.
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