Nurse-Driven Pre-Visit Planning in Primary Care for Annual Wellness

Providing the essentials for patients to understand and make strides to reach optimal health takes a team. A large primary care, urgent care, and specialty care system in the Puget Sound area piloted an alternative model to utilize teammates to top of scope to increase the quality of patient care visits.
To better manage the patient’s overall health needs effectively, our organization funded and formed a team for pre-visit planning. Pre-visit planning (PVP) increases the quality of visits by preparing patient information for the provider and addresses several important topics even before the visit. Completion of PVP by RN was linked to provider time saved. The calculation of saved provider time increases revenue became the source of funding for adding quality of patient care in our initial PVP pilot.
Patients are scheduled one to fourteen days before their in-person annual wellness visit (AWV) with their primary care provider (PCP) through a scheduling panel algorithm working behind-the-scenes of our electronic medical record. PVP is a 30-minute telephone visit where the RN completes medication reconciliation and health risk assessment (HRA) including fall risk assessment, depression screening, cognitive impairment screening, and education of resources, including topics on advance care planning and social determinants of health (SDOH) addressing health maintenance recommendations.
The PVP RN pilot has demonstrated that outpatient care is improved when utilizing RNs to complete pre-visit planning for AWVs. In our 2019 provider survey sampling, five providers showed 100% (5/5 responses, 5 surveys sent) felt a positive difference in their clinic workflow with the PVP completed. In our 2019 patient care survey, 66% (204/309 responses, 10745 surveys sent) felt that PVP was beneficial, and 59% (183/308 responses, 10745 surveys sent) felt their AWV with provider was improved from having PVP. In 2022, we surveyed a primary care provider new to PVP, and he responded positively, stating the work is impactful and makes a positive difference. When a patient presents in-person at the clinic, the telehealth performed nursing assessment of health risks and triage of patient concerns puts the provider in a better position to fully utilize their clinic time to meet the needs of the patient.
The scope of the RN permits assessment and education of patients which contributes to the patient’s ability to better understand and manage their health. This type of health care provides the highest level of quality and efficiency using the strength of all team members. Telephonic pre-visit planning in primary care by remote nurses can be summarized by: preparation – to enhance the time patients have with provider; presentation – of information collected from PVP RN to provider; partnership – with clinical teams and patients.