Good morning Kathryn,
We actually aren't including any orders in our SmartSet. We do ask the patient about their care gaps and mark them accordingly if the patient declines. Otherwise, we keep them on the list for the provider to order during the visit. I don't think there is anything that our LPN does that someone else couldn't do, except he thinks like an LPN. For example, he may connect that a medication is related to a diagnosis the patient didn't mention where someone else may not pick up on that. You are right that there may be opportunities to go beyond the scope of an MA but I am not sure that I have found the overall benefit of that yet. As far as those potentials that you listed, we avoid working on them prior to the new patient appointment because they aren't established yet. Instead, we would highlight those areas for the provider. If the patient needs triage and can't wait until the appointment, we would likely refer them to urgent care, again because they are unestablished. As far as the issues connecting with the patients, we are working on text messaging reminders and options. I think the patients often don't understand what the appointment is or forget about it and they don't like to answer an unknown number. I absolutely agree with you about the need for this to be a value added. My biggest advice is to partner with the providers to make sure this work makes the new patient visits easier for them. I think our SmartSet development meets the providers needs - now we just need to get our schedulers to remember to schedule the visits and for the patients to pick up the phone so that we can confirm that. Always a work in progress.
Angela
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Angela Hall MN RN
Director of Nursing and Clinical Services
Neighborhood Health Center
Portland OR
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Original Message:
Sent: 11-27-2023 13:10
From: Kathryn Williford
Subject: New Patient Nurse Visits
Hey Angela,
This is really helpful. Can you share what orders are included in your SmartSet? Is there anything that your LPN does that cannot be done by an MA or office assistant? I think there will be opportunities for our nurses to go beyond the scope of an MA but it may not be every visit. Potentially, when we discover that a patient has a barrier to care, needs additional resources, or has a concern that needs to be triaged. I suspect that we may have issues connecting with patients prior to their appointment as well. We currently do virtual AWVs with RNs, so I'm hoping we can learn from that process how to decrease no-shows but I do want to ensure that it will be value added for our patients, providers, and nurses.
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Kathryn Williford
Nurse Manager
Duke Health
Raleigh NC
(919)602-8159
Original Message:
Sent: 11-27-2023 12:15
From: Angela Hall
Subject: New Patient Nurse Visits
Good morning Diana,
We have been conducting visits like this but it is an LPN that runs this visits. I do believe that this work could be done by an MA or office assistant though. I don't have any standards or policies because we build a smartset in Epic. I will say this hasn't gone seamlessly for us and it is still a work in progress. We have a lot more learnings currently than a success story. One of our biggest barriers is that the visits are via telephone and the patients often do not take the call or are not prepared for the visit. I would be happy to share more with you if you are interested.
Angela
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Angela Hall MN RN
Director of Nursing and Clinical Services
Neighborhood Health Center
Portland OR
Original Message:
Sent: 11-22-2023 08:05
From: Diana Gardner
Subject: New Patient Nurse Visits
Hello! I am an RN at a family medicine office in Raleigh, NC.
My office is looking to pilot 'New Patient Nurse Visits'. Our idea for these nurse visits would be to update the patient's chart (med rec, history, etc.), preform a learning screening, SDOH screening, obtain ROI's for previous medical records, set expectations and possibly more. The purpose of these visits is to expand provider access and reduce the administrative work needed during the patient's MD/NP/PA new patient appointment.
Has anyone done anything similar? What do you cover in your 'New Patient Nurse Visits'? Could you send us your standards/policies for these types of visits? My manager Kathryn can be emailed at: kathryn.williford@duke.edu. Thanks!
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Diana Gardner BSN RN
Duke Primary Care
Raleigh NC
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