The COVID-19 pandemic has increased demand for primary care services while limiting clinic and provider ability to accept new patients. As demand for primary care grows, new models are urgently needed that can increase access to care while efficiently identifying and addressing care gaps.

The MAHEC Family Health Center new-to-practice adult 18+ patient visit process was identified as an opportunity to improve clinic efficiency and increase scheduling capacity with RN same day pre-visit planning. Due to the pandemic, new-patient-to-clinic visits mid-year 2020 were scheduled as telehealth encounters only.

Consistent reduction in provider time from 40 minutes to 20 minutes for a new-to-practice adult 18+ encounter would allow for an additional scheduling slot opportunity. Adding at least one new to practice adult patient scheduled encounter per day for the four telehealth service-assigned providers would significantly increase new-to-clinic patient access.

A same-day pre-visit planning workflow was developed that uses the RN to full practice scope, provides consistency in assessment and charting, and provides an opportunity for the RN to share information in the SBAR format to the provider. The RN scope of practice introduces robust assessment capabilities to efficiently identify patient needs and care gaps while meeting identified MAHEC provider needs for consistency in medication review and review of systems. Data was collected over the course of 35 patient encounters including provider time in visit, gaps in care identified and addressed, and RN and provider collaboration with warm handoff.

The initiative demonstrated that provider time in telehealth new-adult patient encounters can be reduced below 40 minutes while increasing consistency in recognizing and closing gaps in care. Utilizing RNs for new patient intake provides the scope of practice element necessary for ensuring consistency in medication review and review of systems components of the work-up. Workflow standardization was shown to be crucial for consistency in data gathering, risk assessment screening, and EHR documentation. RN handoff communication to the patient’s provider increased provider perceived ability to focus on the patient’s primary reason for visit and to perform diagnostic work and planning. Study data has informed MAHEC Family Medicine clinical leadership decisions in the development of patient intake standardized EHR documentation accompanied by job aids and training for all clinical staff and providers.

This RN-led process increased access for patients, consistently identified and closed gaps in care, and increased collaboration between clinical staff and providers.

References

Lin, S. Sattler, A., Smith, M. 2020. Retooling Primary Care in the COVID-19 Era. Mayo Clinic Proceedings. 95 (9), 1831-1834.
Sinsky, C., Sinsky, A. MD., and Rajcevich, E. 2015. Putting Pre-visit Planning Into Practice. Family Practice Management. 22 (6) 30-38.

The authors wish to thank Suzanne Shapiro and Brenda Benik for their assistance with the presentation.

Terri Hintz BSN, RN

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