Nurse-Led Visits in Ambulatory Specialty Care Settings: Implementation and Implications for Academic Medical Centers

Purpose: The purpose of this presentation is to discuss the implementation and impact of nurse-led visits in ambulatory specialty care settings at an academic medical center.

Description: Access to health care in the ambulatory care setting can be challenging. Nationally, there is an average 20.6-day wait for an initial appointment with a primary care provider. This wait can be even longer for specialty care providers with a national average appointment wait time of 26 days. Nurse-led visits have gained momentum as a method of optimizing healthcare delivery, improving access to care, and enhancing patient outcomes.

Nurse-led visits, referring to the utilization of current procedural terminology (CPT) code 99211, are a promising approach to enhance patient care in specialty areas within academic medical centers. These visits involve registered nurses (RNs), including clinical nurses and registered nurse coordinators, who possess specialized training and expertise to provide comprehensive care within their specific specialty. Nurse-led visits encompass a wide range of services, including disease management, treatment follow-up, patient education, and coordination of care. Goodman et al. (2021) introduced nurse-led patient education visits in which the nurse would spend an extra 20-40 minutes with the patients to conduct additional patient education. Nordlund et al. (2022) found that registered nurse-led consultations were an effective strategy to meet demand in Swedish pediatric emergency departments.

Evaluation/outcome: In the six-month period of December 2022 through May 2023, 30 clinics participated in nurse-led visits and 125 nurses conducted these visits, with a total of 2,509 nurse-led visits completed during this period. However, when we attempted to do analysis of outcomes, we found a wide variation in charting practices, scheduling of nurse-led visits, and subsequently successful billing for nurse-led visits, making it near impossible to maintain clean data collection or analysis. Anecdotally, our nurses report using nurse-led visits as an effective strategy to improve care delivery. Implications for future practice are to build explicit and consistent charting templates, scheduling workflows, and billing coding. Future research implications include investigating the impact nurse-led visits have from the patient and caregiver, nurse, and provider perspectives. Additional future research is needed to systematically investigate the anecdotal perceptions as well as the operational utility of nurse-led visits.

Chrystal Lewis discloses that she serves as a presenter for Practicing Clinicians Exchange.