Putting Pre-Visit Planning Into Practice
Patient visits can be more effective if much of the information gathering is done ahead of time.
Fam Pract Manag. 2015 Nov-Dec;22(6):30-38.
Author disclosures: Christine Sinsky is an adviser for Healthfinch, a company that develops prescribing software. No other relevant financial affiliations disclosed.
When you walk in to see your next patient, is all of the necessary information assembled, organized, and ready? Or do you spend the first five to 10 minutes of each appointment determining who the patient is, why he or she is here, which performance measures are due, and what care the patient may have received from another provider, the emergency department, or an urgent care center since his or her last visit?
In our own practice, if the first time we think about a patient is when he or she checks in, we are already behind.1–3 There is a lot to be done at each appointment. Consider that the average family medicine patient age 65 or older presents with four problems per visit and, in our experience, one or more care gaps needing to be addressed.4 This is more work than a physician can typically handle alone yet is too important to leave to chance.
Pre-visit planning can help make your patient visits run more smoothly, giving you time to focus on what matters most to the patient and even a little time to spare to simply visit with the patient. Furthermore, you may be able to head home an hour earlier, feeling satisfied with the day and a job well-done, knowing that your patients and staff feel the same.
IN THE AUTHORS' OWN WORDS
Dr. Thomas Sinsky and Debra Althaus, RN, discuss some of the benefits that pre-visit planning provides for their practice.
The objective of pre-visit planning is to help the patient and physician conduct the face-to-face visit more effectively by gathering and organizing information ahead of time so they can devote more attention during the visit to interpreting, discussing, and responding to that information.
Pre-visit planning takes place in several steps:
1. Plan forward, or “The next appointment starts today.”5 The most efficient form of pre-visit planning begins near the end of the previous visit. As the visit draws to a close, the physician and patient decide on next steps, such as planning any lab tests that might be needed before the follow-up appointment. The physician is already familiar with the patient's conditions and medications, so it should take very little time to identify the appropriate tests for the next visit. The patient then may schedule these appointments immediately instead of having to remember to call back in several months to set them up.
In our practice, we use a checklist to help us plan for the next visit. The checklist is part of a form that also includes the date of the patient's last annual exam as well as any upcoming appointments and labs that are already scheduled. This format allows the physician to put today's care and the next visit's care within the context of the patient's ongoing care. The
Referencesshow all references
1. Sinsky CA, Sinsky TA, Althaus D, Tranel J, Thiltgen M. Practice profile. ‘Core teams’: nurse-physician partnerships provide patient-centered care at an Iowa practice. Health Aff (Millwood). 2010;29(5):966–968....
2. Sinsky CA. Improving office practice: working smarter, not harder. Fam Pract Manag. 2006;13(10):28–34.
3. Kravitz RL. Improvement happens: an interview with Christine Sinsky, MD. J Gen Intern Med. 2010;25(5):474–477.
4. Beasley JW, Hankey TH, Erickson R, et al. How many problems do family physicians manage at each encounter? A WReN study. Ann Fam Med. 2004;2(5):405–410.
5. Phrase coined by ThedaCare Health System, a community health system based in Appleton, Wis.
6. Crocker JB, Lee-Lewandrowski E, Lewandrowski N, Baron J, Gregory K, Lewandrowski K. Implementation of point-of-care testing in an ambulatory practice of an academic medical center. Am J Clin Pathol. 2014;142(5):640–646.
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