How will this module help me successfully implement pre-visit laboratory testing?
Outlines strategies to simplify the process of implementation.
Provides answers to common questions about pre-visit laboratory testing.
Gives guidance to address what you may encounter during implementation.
Shares case reports describing how practices are successfully using pre-visit labs.
Pre-visit laboratory testing involves ordering patient laboratory tests for completion before upcoming appointments. This gives physicians the opportunity to discuss results with patients at their visit, eliminating the need to review results later, and coordinate follow-up care.
Interactive Calculator: Pre-Visit Laboratory Testing
Use this calculator to estimate the amount of time and money you could save by implementing pre-visit laboratory testing in your practice. Results should be verified for your specific practice and workflows.
Enter the amount of time (minutes) per day spent by physicians and staff on activities that could be eliminated by pre-visit lab testing.
Six steps to implement pre-visit laboratory testing:
Re-appoint the patient at the end of each visit.
Pre-order labs and other needed tests.
Use a visit planner checklist to arrange the patient's next appointment(s).
Arrange for tests to be completed before the next visit.
Delegate computerized order entry.
Empower staff to manage the inbox.
Step 1Re-appoint the patient at the conclusion end of each visit.
Re-appointing patients at the conclusion of each visit saves time, promotes continuity, and may improve adherence to follow-up visits. It also signals to patients that you want to see them again and will plan ahead to make their visit as meaningful as possible.
Many practices find that scheduling one year or more in advance saves staff time. Some patients will later have to call to reschedule, but this is less work than a system that requires all patients to call to schedule their next visit.
Some practices that choose not to book one year or more in advance instead create a system to store appointment times and associated lab requests, and then contact the patient two weeks before the due date to schedule the appointment and pre-visit laboratory tests. Others will send the patient a postcard asking them to call in. While each of these approaches requires more “touches”, they are reasonable alternatives for clinics that do not schedule a year in advance.
Step 2 Pre-order labs and other needed tests.
Quiz Ref IDWhen re-appointing patients, prospectively identify pre-visit lab tests for the next visit. For example, at the end of an office visit, schedule a patient with diabetes to return in three months to complete a fasting blood sugar and HgBA1c before the visit so the result is available to the patient and physician at the following appointment.
Quiz Ref IDIf patients miss the lab appointment, the appropriate team member can call them, inviting them to come in for the test that they missed and, when appropriate, remind them of their upcoming appointment with the physician. This phone call can serve as a safeguard to reduce no-shows for office visits. The reminder call can also alert staff to the occasional situation where the patient has moved or is not planning to keep their appointment with the physician for other reasons, allowing that time slot to be opened up for another patient.
“Pre-visit lab through point-of-care testing saved our clinic $25 per visit in physician and staff time.”
J. Benjamin Crocker, MD Internal Medicine, Ambulatory Practice of the Future, Boston, MA
Step 3 Use a visit planner checklist to arrange the patient's next appointment(s).
A visit planner is a checklist that allows the physician to indicate the interval until the next appointment and any associated labs to be scheduled. It should be quick and convenient to use, requiring no more than a few seconds of physician time. The visit planner is most useful if it is customized to the practice or an individual physician or specialty.
Visit planner checklist (49 KB)
Step 4 Arrange for tests to be completed before the next visit.
Some organizations arrange for patients to have lab testing a few days before their appointment with the physician, while others have developed processes for rapid turnaround of the lab testing and results, so the patient may come for the lab test earlier on the day of their appointment with the physician. The goal with each approach is to have the lab results available at the visit so the physician and patient can discuss them face-to-face.
Educating the patient about the importance of monitoring their condition at appropriate intervals increases patient engagement. This allows the patient and physician to complete all management decisions at that time, rather than having the results slowly return to the office, generating multiple phone calls and additional follow-up work for the physician and care team to conduct.
Step 5 Delegate computerized order entry.
Quiz Ref IDUsing the visit planner checklist, the physician can check off laboratory tests that need to be administered before the next visit. Entering this information into a computer may require one to two minutes. Several minutes more per task can add up to hours of time per day. Delegating order entry allows physicians to focus on providing high-quality patient care.
Step 6 Empower staff to manage the inbox.
Staff can use physician-established protocols to review results and forward only those that are abnormal to the physician. This allows the physician to review the majority of labs only once, at the time of the appointment, and is referred to as “just-in-time” information processing. For example, if a team member reviews a patient's lab results for urgent abnormalities prior to a visit and finds none, the physician will only need to review the results once at the time of the patient's visit.
Scheduling future appointments and pre-ordering needed laboratory tests before the next visit sends the right message to patients. Proactively preparing your patients for their next appointment with pre-visit laboratory testing will ensure efficient use of time at each visit. Patients who are more actively involved in their own care generally experience better health outcomes and regularly obtain preventive care, such as having lab work done at the appropriate intervals. Additionally, this approach encourages the team to take a more active role in reviewing laboratory results to support the physician during a visit.
Re-appointRe-appoint:
To schedule any follow-up appointments for patients at their current visit.