Friday, March 13, 2009

Redesigning Primary Care at MGH Revere

Front row, from left, Sina Sakhen, MA; Courtney Miller, MA; Melissa Lopez; Asmaa Sahrour, MA; and Wheeler. Back row, from left, Allison McDonough, MD; Winnie LeVine -Sawyer, RN;  Lisa Valentine; Eric Weil, MD; Michele McHugh, NP; and Niles.

Is it possible to reduce wait times for physical exams from nine months to two months at a busy primary care practice without adding staff? According to Joan Niles, RN, MGH Revere HealthCare Center Adult Medicine unit nurse leader, and Amy Wheeler, MD, MGH Revere Adult Medicine unit chief, the answer is yes.

Niles and Wheeler recently spearheaded a primary care redesign project to address the wait time for physical exams at the health center. Prior to the initiative, the demand for physicals was more than twice the available time slots. Doctors were reluctant to have secretaries schedule more than one or two physicals per four-hour session because of the amount of time these appointments typically require.

To address the challenge, Niles, Wheeler and the staff at MGH Revere developed a new process for scheduling and conducting physical exams. While the new process involved only a number of small changes, it led to a vast improvement. Primary care physicians were able to complete an average of nine physical exams in a four-hour session, which amounted to a 50 percent increase in pro-ductivity. The changes also led to a more efficient work schedule for physicians and pleased patients who received special attention from the care team both before and after seeing their physician. Central to the new design was the expanded role of the medical assistant. As part of the redesign process, medical assistants began to collect information from patients by calling them a week prior to their appointment. They asked patients if they wanted to discuss special concerns with their doctor, and they inquired about the patients’ medications, refills they needed and health screenings that may have been done or were due. This pre-appointment call decreased the amount of work physicians needed to complete during the exam. Also, with the information, medical assistants could prepare the exam room prior to the visit with any special supplies or equipment. After the visit, medical assistants completed lab requi-sitions, provided the patient with educational information and prepared referral paperwork, which was specified by physicians using a simple checklist.

“Physicians, medical assistants and patients were delighted with the results of the redesign,” says Wheeler. “One physician told us it was her easiest session, and there were reduced wait times for physicals as well as fewer no-shows. Most importantly, patients reported that they were pleased with the special attention they received from the care team.”

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