Preparing the necessary clinical information for a patient visit is time consuming. Without a clear process for delegating tasks, such as gathering, retrieving and reviewing patient information, physicians may spend more time completing administrative tasks than focusing on complex clinical issues and engaging with patients in the exam room.
In an episode of the “AMA Moving Medicine” podcast, AMA Chief Experience Officer Todd Unger is joined by Christine Sinsky, MD, to discuss expanded rooming and discharge protocols.
Below is a lightly edited transcript of their conversation. You can tune in on Apple Podcasts, Google Play or Spotify and follow along with the AMA STEPS Forward™ module on the AMA Ed Hub™.
Unger: I’m excited to talk to you today about expanded rooming and discharge protocols. Why is it important to expand rooming and discharge protocols?
Dr. Sinsky: Well, Todd, that's a great question. I think the answer lies in the fact that there is too much work to be done by just one person, and it's too important to be left to chance.
The only way we're going to be able to meet all the requirements for patient care is by having a team and by having very clear responsibilities about who does what. I also believe that our team members, our medical assistants (MAs) and our nurses, are able to contribute much more to patient care than simply escorting the patient down the hall, bringing them to the room and doing a set of vital signs.
By developing protocols and processes, our medical assistants and our nurses can make sure that the standard work of every patient visit gets done routinely and reliably for each patient. When the standardized, predictable work of a practice is built in and happens by default, the physician can relax, knowing that that work has been done and can focus on the unique problems that the patient brings to them
In addition, the nurse and medical assistant can really do a lot to help the patient get the most out of their visit. For example, the medical assistant or nurse can help set the agenda, so that the patient has an opportunity to think about, and be really clear about, what the most important things are for them to accomplish in the visit. The medical assistant or nurse can help them shape that agenda and then can help communicate that on to the physician.
By expanding the responsibility of the rooming staff and by empowering that rooming staff to do more for patients, we get better care.
So, what are some of those things that rooming staff can do? Well, one is help the patient feel welcome and known and prepared for. Second is to help the patient set their agenda and the priorities. Third is to do medication reconciliation. To go over with the patient all the medications that they're on. Make sure that the list that we're starting out with for the appointment is accurate. My own nurses will often call the pharmacy to find out what the patient's been filling if the patient isn't really certain that they're on a certain medication, and that allows their care to be safer and more effective.
The rooming staff will also review any allergies and will update the record with any new health concerns that have developed for the patient and, importantly, will close care gaps. If the patient is due for an immunization or is due for a cancer screening, by protocol, the rooming staff can give that immunization or can schedule a colonoscopy or other preventive health measure that the patient is due for.
Rooming staff can also, when appropriate, provide information about advance directives and begin that conversation with the patient. That allows the conversation with the physician to be more effective. Medical assistants and nurses can also do symptom-driven tests before the physician comes in the room. If a patient has a history of asthma, the rooming staff can, by protocol, do a set of pulmonary function tests before the physician comes in the room.
Finally, for new patients, the nursing staff in my practice introduce the patient to the practice. They tell the patient what they can expect from us. They introduce themselves, by name. They tell them that we'd like them to call if they have any questions or concerns. We talk to them about how we do lab ahead of the appointment. And, we talk to them about how we handle their prescriptions so that they know how to interact with us, and we know more about them.
Unger: How can expanding rooming and discharge rules for that support staff also help your practice from a financial standpoint?
Dr. Sinsky: Well, when nurses or medical assistants are doing some work that would otherwise fall to the physicians, they're saving the physician time. So, by doing medication reconciliation, by updating immunizations, by updating the past family social history, the staff saves several minutes per visit for the physician.
You can estimate how much time they save … and then use our calculator on STEPS Forward to identify how much that saves the practice over the period of a year. In addition to saving time, by having higher-quality metrics, many practices have additional financial revenue that will come to them because of that.
Unger: What tasks can a nurse or MA take on as part of the expanded patient discharge protocol?
Dr. Sinsky: When a patient leaves their appointment, there are several things that can be done that make it more likely that they will understand what transpired during the appointment, and that they're more likely to adhere to the recommendations from their team.
At the completion of the appointment, the nurse or the medical assistant can print up a new medication list and can highlight what the changes are that were made. That makes it more likely that the patient, or their family, are able to help with medication adherence because it's very clear to them what was done.
In addition, for practices that use an electronic health record that has an after-visit summary, the rooming staff can print that after-visit summary, and again, go over the instructions a second time with the patient so that they have the next steps both in writing and verbally reinforced.
Unger: How do you start involving a nurse or MA in the rooming and discharge activities?
Dr. Sinsky: We can involve our rooming staff in these expanded roles in a couple of ways. One is we can involve them in the design of the new task to begin with. Again, so that the people who are doing the work are helping to design the work.
Secondly, we can be really clear, then, about what the final process that's been decided upon is. And one way to do that is by having a rooming checklist. A printed checklist that the rooming staff can look at to make sure that they have done all the tasks that are part of the standard work of rooming. Likewise, we can create a discharge checklist.
Similar organizations have found it helpful to train the rooming staff in the new processes in a training lab environment so that the staff can practice the new skills that they're learning in a safe and comfortable environment.
Unger: Do you have any final thoughts or tips about these protocols?
Dr. Sinsky: The more meaningful the work is for our rooming staff, the more they're able to contribute. And, finding ways to increase the joy, purpose and meaning of work for all members of the team results in a better work environment for physicians and a better care environment for patients.
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You can find more episodes of “AMA Moving Medicine” and other great AMA podcasts on Apple Podcasts, Google Play or Spotify, or on the AMA website.
