Haines/Systems Concept for Patient Management

15

usually the hospital provides the staff). The RN provid-

to be given, the physician checks what is needed on the

ing continuity and assistance to the doctor is a nice qual-

patient's encounter form, activates the staff's signaling

ity of practice life at XYZ Ortho.

light, leaves the chart and the encounter form in the

Of the six half-days the RN is in the office, his or

chart rack outside the room, and goes to the next pa-

her tasks include triaging phone calls and doing prescrip-

tient. The light signal system can also notify the doctor

tion refills. (In most other practices, such triaging/refills

of a phone call so the staff does not have to interrupt

occurs in a central triage center. At XYZ Ortho, triag-

an exam. Different types of flashes can indicate that the

ing/refills may be delayed if the RN is in surgery or oc-

phone call is from another doctor or possibly the doc-

cupied with another patient in the office.) In other offices,

tor's spouse. This also eliminates the need for the staff

casting and suture removal are done by cast techs or med-

to track down the doctor or use overhead paging.

ical assistants; surgery is scheduled by surgery schedulers.

· Room sequencing light signal system (RSLSS).

In other practices these staffers do not bond the pa-

When the doctor exits one exam room, it is in every-

tient to the practice (although we have worked with prac-

one's interest for him or her to get to the next patient,

in priority, as quickly as possible. An RSLSS system

tices where the bonding did occur through the surgery

consists of a button outside of each exam room con-

scheduler, who was not an RN). It appears that XYZ Ortho

trolling a light signal. As the doctor exits an exam

needs the doctor's nurse as an RN 40 percent of the time

(in surgery); the rest of the RN's time is spent in the of-

room, he or she turns the RSLSS light off there, and

fice. Part of the office time is spent triaging phone calls

the light at the next room in sequence begins to flash.

The doctor then goes to that room, gets the chart, and

and doing prescription refills, tasks for which an RN is

starts managing that patient encounter. The clinical

recommended. For the remainder of the office time, the

staff had put this patient in sequence by activating the

RN should be viewed as a regular staff person, and their

excess capability/cost above a regular staff person is a perk

RSLSS button as the staff exited the exam room after

for the doctor affecting quality of life.

taking the patient there. Many of the systems now al-

low the float nurse to override the priority of the next

patient in order to move returning x-ray patients (or

COMMUNICATION SYSTEMS

an emergency) to the top of the queue.

Electronic medical records. As EMR gets more so-

The communication systems are what bind the prac-

phisticated, they support many of these communication

tice together and allow it to benefit from good staffing

functions. For example, pulling charts and moving them

and spatial arrangement concepts. The idea behind good

throughout the clinic becomes a thing of the past (as are

communication systems is to eliminate the need for walk-

lost charts). Some EMR systems let doctors signal staff

ing or verbal communication, whether it is face to face or

that something needs to be done; they can also tell you

by telephone. The transferring of information should be

which patient is next. You need to think through what

done to allow both the doctors and the staff to continue

will be best for your practice, however. Total reliance on

to work at their own pace.

EMR means that medical assistants have to continually

We suggest several communication concepts:

hover around their computers to look for instructions;

Chart pulling. Pull the charts for that day's patients

they cannot handle things on the fly as they move among

and place them at the nurse's station. When the patient

the patients. You and your staff may be best served by a

arrives, print the patient's encounter form to a printer lo-

combination of EMR and the more traditional commu-

cated in the MA station. This notifies the clinical staff

nication systems.

which patient has arrived without anyone leaving the work

area. Otherwise, the staff must walk around the corner to

see if the next patient is ready to be seen. This trip is made

CONCLUSION

many times throughout the day, pulling the staff away

form the doctor.

These guidelines are intended to provide a frame-

Light signaling systems. These systems allow the

work for practices to review their office methodology.

clinical staff to communicate with the physician seeing pa-

Applications will vary according to practitioners' styles and

tients, without the staff having to stand outside the exam

constraints of finances, space and personnel availability.

door or the physician having to search for the staff. We rec-

Although the example cited here involves an or-

ommend two types of light signal communication systems:

thopedic practice, the principles enunciated are applica-

■

· Staff notification light signal system. If orders need

ble to a wide variety of generalists and specialists.

Journal of Medical Practice Management®

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