P14B

Redesigning Care Delivery to Define the Ambulatory Care Nursing Role

Free
Standard Price

Background: The role of nursing in ambulatory care has historically been ambiguous. AAACN’s recently revised position statement provides a framework to guide organizational approaches to effectively utilizing registered nurses in this environment. Numerous barriers exist to implementing the recommendations in current practice.

Purpose: This presentation will describe our approach to enhancing the registered nurse role in a multi-specialty, multi-site, provider-practice group organized around an independent-provider practice model. Application of transformational and servant leadership theories to effect practice change in a project of this scope will be discussed.

Methods: Our organization employs over 400 providers and 278 clinical staff at over 70 sites, including 159 registered nurses. Prior to this initiative, clinical roles and staffing model varied across sites regardless of panel acuity, and individual sites varied in the extent and mode of implementation of the RN care coordinator role. Inconsistencies in documentation revealed lack of standards for data collection. Further, no empirical data existed to quantify care-coordination activities, and staff interviews revealed wide variation in workflows from site to site. Beginning with primary care sites, nursing leadership collaborated with operational and medical leadership to standardize workflows including pre-visit prep, office visit intake, hospital follow-up, complex care management, and panel management. A staged roll out to individual sites is utilized with onsite practice coaching and education. Informatics tools were acquired or enhanced to establish and automate workflows and to organize tasks by patient complexity. Implementation is ongoing, with 8 primary care sites currently engaged and plans to expand to the remaining 11 sites by the end of 2019.

Results: This process has produced data that describes clinical tasks across defined patient populations. Our hospital follow-up (HFU) program serves as an example: since implementation, 873 patients have been enrolled in the HFU program at discharge, with 278 scheduled for follow-up office visits; 75% of which were scheduled within the 7-day timeframe instituted in our new workflow; 10 additional process-level data points exist for this HFU program. A total of 26 data-points are now available across 3 workflows to measure care coordination activities. Similar process-specific data is available for each workflow and will be reviewed. Measurement of clinical outcomes is in development.

Discussion: Through the implementation of informatics tools to stratify patient acuity and drive workflow, care coordination activities are identified for both low- and high-complexity patients. This clarifies the RN care coordinator role to include high-risk care coordination activities, care management, and facilitation of practice panel management. By defining and providing a means to measure rooming and pre-visit activities for non-complex patients, a framework for a medical assistant role is established. This creates the opportunity to define a nursing role for the RN and LPN for the remainder of care coordination and care planning for moderate-complexity patients. 

Speakers

Speaker Image for Jared Caron
Jared Caron, BSN, RN-BC

Related Products

Thumbnail for Transitional Primary Care Clinic - Care Coordination across the Continuum
Transitional Primary Care Clinic - Care Coordination across the Continuum
Access to primary care services is a central component to a patient’s successful transition after a hospitalization or an emergency department (ED) visit…
Thumbnail for Patient Engagement: A Key to Quantify the Impact of Nursing in Care Coordination
Patient Engagement: A Key to Quantify the Impact of Nursing in Care Coordination
Purpose: Management of chronic disease is changing the focus and delivery of healthcare. Approximately 70% of deaths annually and costs for chronic disease now consume 86% of U.S. healthcare dollars…
Thumbnail for Improved Patient Satisfaction Scores in Pediatric Urgent Treatment Clinic with RNs and Care Coordination
Improved Patient Satisfaction Scores in Pediatric Urgent Treatment Clinic with RNs and Care Coordination
Background: New models of healthcare delivery and reimbursement are emerging and place a high emphasis on improving the quality of care provided to patients and the experiences of the patient or patient’s family…
Thumbnail for Onboarding Care Navigators at Michigan Medicine
Onboarding Care Navigators at Michigan Medicine
A care navigator (CN) team was developed starting in 2012 under the Michigan primary care transformation project consisting of 28 care navigators, working at 14 primary care practices utilizing the patient-centered medical home (PCMH) to improve patient health…
Privacy Policy Update: We value your privacy and want you to understand how your information is being used. To make sure you have current and accurate information about this sites privacy practices please visit the privacy center by clicking here.