The Nurse Closer: Using Nonclinician Staff to Make Patient Visits More Efficient

 

With a little training, nurses can wrap up the patient visit, reducing errors, improving patient satisfaction, and freeing up time for providers.

Fam Pract Manag. 2019 Jul-Aug;26(4):13-17.

Author disclosures: no relevant financial affiliations disclosed.

Traditional office-based processes are broken. While other industries have embraced working in teams, medicine continues to largely encourage clinicians to function as individuals. Individual efforts, lacking standardization, are prone to variable results. Meanwhile, dated medical office workflows do not leverage newly available skillsets and technology. This can diminish efficiency.

Our practice developed the “nurse closer” model as a response. This model systematically drives quality by combining team-based care with technological advances and encourages all team members to work to the top of their licenses. The goal is to achieve higher value care without increasing practice expense or provider burnout. In the time since we implemented this change, we have reached that goal and even increased revenue.

KEY POINTS

  • Unempowered staff and outdated office practices contribute to inefficiency and provider burnout.

  • Having a trained nurse or other staff member handle documentation and order entry at the end of patient visits can increase patient satisfaction and save the physician or other provider time.

  • A “nurse closer” can also help improve care quality, which can lead to higher revenue from payers.

WHAT THE NURSE CLOSER MODEL LOOKS LIKE IN PRACTICE

Our clinic is a Federally Qualified Health Center (FQHC) that serves approximately 7,000 patients per year through 16,500 visits in a rural setting. One physician and four advanced practice registered nurses serve as clinic providers. Support staff includes four nurses (one registered nurse and three licensed practical nurses), a nursing supervisor, and five full-time certified nursing assistants. Our previous, traditional office-based process included a provider-led office visit followed by patient checkout with front-office staff.

Beginning in October 2017, we implemented the nurse closer model. Each morning begins with a team huddle of the provider, a nurse, and a nursing assistant. The team uses a data filtering system in the electronic health record (EHR) to identify the preventive care needs of that day's patients and create a checklist to be used during their visits. As patients arrive, they check in at the front desk and provide any necessary payment. The team's nursing assistant then rooms each patient and completes the clinical intake process by entering patient data into the EHR. The nursing assistant leaves the exam room, gives a brief synopsis of the patient to the provider, and then rooms the next patient. The provider enters the exam room and performs a normal patient visit.

The nurse closer model then begins as follows: The provider, typically toward the end of the patient visit, contacts the team's nurse to come to the exam room. For more complex p

ABOUT THE AUTHORS

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Dr. Fisher is medical director of First Care Clinic in Hays, Kan....

Bryan Brady is CEO of First Care Clinic. Rhiannon Maier is the director of quality and data at First Care Clinic.

Jordan Gabel is the nursing supervisor at First Care Clinic.

Danielle Windholz is the operations manager at First Care Clinic.

Author disclosures: no relevant financial affiliations disclosed.

References

1. Gawande A. The Checklist Manifesto: How to Get Things Right. 1st ed. New York, NY: Picador; 2011.

2. Downing NL, Bates DW, Longhurst CA. Physician burnout in the EHR era: are we ignoring the real cause? Ann of Intern Med. 2018;169(1):50–51.

3. Cox KB. The effects of unit morale and interpersonal relations on conflict in the nursing unit. J Adv Nurs. 2001;35(1):17–25.

 
 

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