How will this module help me implement expanded rooming and discharge protocols?
Outlines five ways to expand staff responsibilities.
Provides answers to common questions about expanding rooming protocols.
Includes case reports describing how other practices implemented new rooming protocols.
Provides rooming and discharge checklists to help you with implementation.
What are expanded rooming and discharge protocols?
Expanded rooming and discharge protocols are standard work routines that enable staff to take on additional responsibilities. Physicians alone cannot do all the work needed for most office visits. Quiz Ref IDWith expanded rooming and discharge protocols, the nurse, medical assistant (MA) or other clinical support staff can use their skills to create a smooth visit for the patient and a satisfying clinic session for the entire team.
Interactive Calculator: Expanded Rooming and Discharge
To estimate the amount of time and money you can save by implementing expanded rooming and discharge protocols in your practice, enter the number of patient visits per day and physician time spent on rooming and discharge tasks per day.
As part of the expanded rooming protocol, the nurse or MA can complete the following tasks:
Identify the reason for the visit and help the patient set the visit agenda.
Perform medication reconciliation.
Screen for conditions based on protocols.
Update past medical, family, and social history.
Provide immunizations based on standing orders.
Arrange for preventive services based on standing orders.
Assemble medical equipment, if needed, before the physician enters the exam room.
Conducting these activities during patient rooming will enable the physician to spend more time directly interacting with the patient and family, rather than focusing on these elements of the visit.
Quiz Ref IDAs part of the expanded discharge protocol, the nurse or MA can complete the following tasks:
Print and review an updated medication list and visit summary.
Reiterate to patients the medical instructions prescribed by the physician.
Coordinate the next steps of care.
This augmented patient discharge process will ensure that patients understand and remember their discharge instructions, leading to improved treatment adherence.
Five steps for involving staff in rooming and discharge activities:
Identify current workflows.
Create a rooming checklist.
Refine the rooming checklist.
Create a discharge checklist.
Provide ongoing staff training.
Step 1 Identify current workflows.
Write down the tasks that the nurse or MA currently completes during rooming, such as obtaining vital signs, documenting the reason for the visit, and tasks completed after the visit.
Step 2 Create a rooming checklist.
Create a wish list of tasks that the clinical support staff could do before and after the physician component of the visit to improve care and reduce physician time on routine functions. Your list might include reconciling medications or identifying the patient's agenda for the visit. Next, pick one or two of these tasks and try them out for a week. Then pick two more and continue to refine the list. Encourage feedback and suggestions during team meetings or morning huddles to ensure that the new process is working for patients, physicians, and team members.
Rooming checklist (37 KB)
Step 3 Refine the rooming checklist.
Over a period of several weeks, refine the rooming checklist based on team feedback and post it close to where the work is done. For example, the checklist can be placed in workstations and exam rooms so that the care team can easily access and refer to it. Making the checklist easily accessible will help the team gain confidence and consistency in performing their new responsibilities.
“We developed a greater role for our medical assistants so the physicians don't have to shoulder all of the work.”
Beverly Loudin, MD, MPH, Medical Director, Patient Safety & Risk Management, Atrius Health, Boston, MA
Step 4 Create a discharge checklist.
Similar to how the rooming checklist was developed, create, refine, and post a list of tasks that nurses or MAs will do after the physician leaves the exam room. Note: Not all patients or practices will need a discharge step. This step can be used as needed.
Discharge checklist (34 KB)
Step 5 Provide ongoing staff training.
Quiz Ref IDTraining often occurs on the spot. For example, the physician can explain a new task or provide feedback regarding the way the support team documents particular elements of the patient rooming or discharge process. Regular team meetings provide another opportunity for ongoing education. Some organizations may create skills assessments to formally sign off on an employee's acquisition of new skills, such as performing a diabetic foot exam. The more comfortable nurses and MAs become with their new responsibilities and enhanced roles, the greater the contribution they will make—and the more they will enjoy their work.
“A lot of the work has already been done for me, so I can spend more time with the patient and less time looking at the computer.”
Mary Wild Crea, MD, Pediatrics, Fairview Health Services, Rosemount, MN
Expanded rooming and discharge protocols address inefficient workflows by organizing and standardizing common tasks that the practice team performs during patient visits. The strategies in this module will enable practices to create personalized patient rooming and discharge checklists to increase patient and staff satisfaction with the care being provided.
Standing ordersStanding orders:
A protocol-driven approach for providing care, such as established procedures for renewing prescriptions and ordering laboratory tests and health screenings. State laws and regulations may address to whom and what can be delegated by standing order.