Rethinking Workflow: Team Rooming for Greater Efficiency
This physician and medical assistant jump-start patient visits by teaming up and reversing some traditional roles in the exam room.
Fam Pract Manag. 2018 Jan-Feb;25(1):15-20.
Author disclosures: no relevant financial affiliations disclosed.
As physicians search for more efficient ways to care for patients, a common refrain is that all medical staff must operate “at the top of our licenses.” This often involves assigning medical assistants (MAs) and nurses all tasks that do not involve the exam or medical decision-making.
However, this is not the only path to greater efficiency and can actually lengthen and complicate visits. We implemented a “team rooming” concept in which the physician (Dr. Cuenca) and MA (Lisa Perry) reverse certain roles as we begin the patient visit. This approach, combined with previsit planning, has led to more streamlined visits for patients, improved quality performance, and significantly better work-life balance at no additional cost.
Efficiency can be gained by “team rooming,” a workflow innovation in which a medical assistant conducts the initial history and obtains vitals while a physician documents relevant findings and enters orders as diagnostic and other needs emerge.
Previsit planning to identify preventive service needs and compile test results and other details boosts efficiency and quality.
Team rooming and previsit planning have saved time and improved satisfaction and quality without adding cost.
HOW OUR PROCESS WORKS
We work in an otherwise traditional multispecialty group with two physicians, two physician assistants, one medical assistant per provider, and a front office of four. We average 15 patient visits a day – mostly established patient visits with some walk-in, urgent care visits mixed in. We used to approach patient visits as most providers do now: The MA escorts the patient from the waiting area to the exam room, obtains the chief complaint, brief history, and key vitals, and inputs the information into the patient record. After rooming is complete, the physician greets the patient, obtains additional history, completes an exam and evaluation, and generates orders. The MA completes the orders, the physician finalizes the assessment and plan, and the MA prepares the exam room for the next patient. This system had its drawbacks, notably that some or all of the related documentation, referrals, and other paperwork accumulated for the physician to complete at the end of the day.
When we opened our panel to patients insured by Medi-Cal, California's version of Medicaid, in 2016, we found that these visits require additional paperwork (such as Medi-Cal “Staying Healthy Assessments”) and, on average, more complex care. Patients insured by Medi-Cal often have multiple chronic medical conditions, may not regularly seek preventive care, and often arrive for visits with a long list of items to discuss. Using our traditional visit workflow, we found we were quickly falling behind, which affected both the patients' and our own satisfaction with the care
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