Guidelines, checklists, and requirements have made the primary care visit increasingly complex and increasingly frustrating for many physicians. Finding ways to improve workflow, better manage the flow of information, and empower support staff is critical. Christine Sinsky, MD, shares 12 strategies – rooted in the principle of working smarter, not harder – that transformed her practice.
1. Pre-appointment labs. Have the majority of patients' lab tests and X-rays performed before the appointment so that test results are available for interpretation and care planning at the visit.
2. Chart preparation. Prior to the patient's appointment, nursing staff should organize all of the pertinent information for the encounter, such as gathering reports from consultants and flagging needed services, so the physician does not have to hunt for medical information.
3. Pre-appointment patient questionnaires. A pre-appointment questionnaire helps the physician understand the patient's concerns and primary agenda before entering the exam room and provides a jumpstart to updating the family and social history and completing the review of systems.
4. Empowered nurses. The more informed and engaged nurses are, the smoother the practice will operate. Use standing orders and protocols that allow nurses to operate at the top of their license.
5. Physician preparation. Take a few moments to know the purpose of the visit and to review the patient’s data before the appointment so you can formulate a tentative plan.
6. Improved interactions. Some basic interpersonal skills such as making eye contact with the patient as you enter the exam room can go a long way toward improving the interaction. It can also be helpful to ask, “What else do I need to know?” or “What else is going on in your life?” to develop context.
7. Prescription management. To reduce time-consuming phone calls related to refills, write most prescriptions for a one-year supply (e.g., a three-month supply with four refills), or for as long as your state law allows.
8. A post-appointment order sheet. The post-appointment order sheet allows the physician to simply check off what new tests or follow-up visits are needed. The order sheet is then routed to the receptionist, who schedules the items ordered.
9. Dictation templates. Documentation time can be cut in half by using dictation templates for standardized segments of the visit, such as the physical exam of a female patient who is post-menopausal.
10. A simplified coding rubric. Coding cheat sheets can help clarify the requirements for each level of service and guide code selection. Develop your own coding rubric, or find one that works for you.
11. The annual exam as an organizing structure. The annual exam is an excellent time to address prevention, coach patients on healthy lifestyles, and perform an annual review of each chronic medical condition, instead of addressing these issues “on the fly” whenever patients happen to be seen for acute medical concerns.
12. Rapid access. A simple, patient-centered scheduling system not only increases patient satisfaction but is also more efficient. If a patient calls with an acute problem, offer an appointment that day or any day of the patient's choosing. But if a patient is being seen for a chronic disease, go ahead and schedule the patient's next checkup so you can plan appropriately for it.
Implementing any one of these strategies can improve efficiency, but together they can transform your practice.
Read the full FPM article: “Improving Office Practice: Working Smarter, Not Harder.”
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