Ambulatory Care Transformation with a Focus on Structural Optimization Leading to Excellence in Clinical Quality Outcomes

Learning outcome: The audience will be able to discuss the benefits of a centralized model compared to a decentralized model for prescription renewal management, understand the components required for a prescription renewal program, evaluate best practices with prescription renewal management, and leave with tips on how to begin within their practice environment.

In the post-pandemic resource-scarce environment, nursing leaders and healthcare executives must find innovative and scalable approaches to provide patients with safe and quality care. In many ambulatory care practice environments, a proportion of the work of ambulatory care nurses involves prescription renewal management per protocol. In addition to being a key driver for patients' timely access to care, managing prescription renewal requests in a timely manner also has other benefits such as decreasing physician and provider workload and decreasing repeat calls.

In 2020, the primary care department within a large multi-site ambulatory care medical practice group recognized the need to develop a new model to manage the large volume of incoming prescription renewal requests. Three years later, what started as a pilot involving 4 primary care practices has evolved into a successful and rapidly growing centralized nursing prescription renewal team that now supports 56% of the eligible primary care practices within the group.

Significant changes were necessary to successfully develop and operationalize the prescription renewal team including the development of new standard work, pool (in-basket) management process development, the development of a pool (in-basket) report that allows for data collection and analysis, the development of a staffing model, the development of new effective communication channels, and the implementation of a quality assurance process.

Since 2020, 14 of the 25 eligible primary care practices have merged into the centralized prescription renewal team and the primary care department has benefited from a greater than 25% reduction in prescription message handle time and a decrease in the turnaround time as the centralized team addresses 85% of renewal messages within 24 hours.

Overall findings from this work indicate that a centralized model for prescription renewal management is more efficient than a decentralized model. Additional benefits of centralizing include strong nurse engagement and retention, a standardized hybrid staffing model, and decreased workload for physicians and providers.

Nursing leaders should advocate for centralized, standardized care delivery models when appropriate. Due to the success of this model, the organization chose to fund a pilot to embed prescription renewal technology into the electronic medical record. The pilot begins in the fall of 2023. At the conclusion of the EMR embedded renewal pilot, we expect to see a further decrease in prescription message handle time which in theory should allow the remaining eligible practices within the department to join the centralized prescription renewal team without adding additional nursing staff.

Jennifer Wall discloses that she is employed by FTI Consulting, Inc. as a nurse.