Process RedesignConnie Sixta, RN, PhD, MBA Patricia L. Bricker, MBA

Reasons for Visit Redesign • Assure information needed for the visit is available• Decrease wasted time during the visit• Increase the value of the visit by addressing all needs • Prevent re-work related to non-completed labs/tests • Increase visit efficiency by staging completion of tasks• Increase provider capacity by making sure the provider

does provider tasks • Increase team capacity through maximization of skills

and use of standing orders• Increase care effectiveness by addressing priority needs • Increase overall visit throughout by increased planning

and organization

Redesign the Pre-visit, Visit, and Post-visit Processes Pre-visit

• MA completion of clinical guidelines per standing orders (i.e. A1c, LDL, microalbuminuria, eye exam) prior to the visit

Visit • MA/RN review of current meds, completion of screenings,

immunizations, self-management goal setting per standing orders prior to physician-patient interaction

• Provider management of clinical outcomes, risk, etc.

Post-visit • Follow-up of new prescriptions, response to meds,

completion of referrals

Sample pre-visit, visit, and post-visit processes

MA faxes request for retinal exam report to ophthalmologist

MA reviews eye exam report, A1c, LDL, and

microalbuminuria reports and creates patient report card

MA identifies guidelines per patient that need to be

completed per standing orders & highlights them

Sample: Pre-visit Process

MA calls & reminds patient of visit; confirms eye exam completion; asks patient to

get A1c, LDL and microalbuminuria

completed & bring meds to office

1-2 weeks ahead, MA identifies DM patient

scheduled for appointments

 

Sample Visit Process

Patient (Pt) checks in at front desk. Pt given

depression screening & self-management (SM) tool

to complete

Front desk notifies MA of Pt arrival

MA takes Pt back to room, completes/documents Ht, Wt, BP, BG,

history, depression screening & reviews Pt meds versus EMR, report card &

assists Pt in setting SM goal

MA enters data into the risk assessment tool

MD reviews lab, risk status, and current meds with Pt.; orders new BP & A1c meds; discusses new treatment plan

and reinforces Pt SM goal

MA asks Pt to recap conversation with MD, share SM goal, self- care needs/schedule

(closing the loop)

MA and Pt agree on date, time, and purpose of follow-up

phone call.

MA huddles with MD to discuss labs, Pt

concerns, problems, risk, report card

Pt has no questions so MA takes Pt to

checkout

Sample Post-Visit Process

MA reviews daily call schedule and calls Pt at agreed upon time

MA introduces self to Pt and asks how the Pt is doing since the visit

Pt describes how she is feeling, shares concerns, BP log,

response to meds and success with SM goal

MA documents concerns and response to meds and success with SM goal. Tells Pt next step

is review with MD

MA calls Pt back and relays discussion with MD that Pt

needs to continue new medication

MA reviews BP log, & response to new med with MD;

MD decision to continue med

MA schedules follow-up call with Pt and closes the loop

Major Changes• Patient totally prepared for visit with lab and

referral reports completed so that clinical outcomes can be addressed

• Prior to MD-patient interaction, standing orders completed, data collected, screenings done, and SM goal set

• MD-patient interaction focuses on patient risk, interventions needed, plan of care and reinforcement of SM goal

• Visit pre-planned and organized to give patient highest value

What Does Your ProcessLook Like?