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Maintaining Medical Practice Work Flow


Interruptions are part of daily life at a medical practice, but by addressing frequent work flow issues proactively, you can maintain great patient care.

We all face time constraints in our daily practices. So how do we deal with the daily tasks that need to be addressed without interrupting our regular practice work flow?

In a Utopian practice, the physician would show up for work each day, log on to his/her tablet PC and go in and start seeing patients. There would be no interruptions from pharmaceutical representatives, phone calls from the hospital wards or nursing home, nurses knocking on the door asking you to come to the phone, etc. Yes, it would certainly be nice if these interruptions did not occur, but unfortunately, such is the life as a physician. What we can control, however, is how these interruptions affect our day-to-day operations.

Every employee in our office loves to see the drug reps walk in. They are always dressed nice, wear a big smile, bring doughnuts and snacks, and of course they drop off medication samples. In my busy practice, we were an early target for reps and in the early years of my practice we would get no fewer than 10 requests to 12 requests for "just five minutes of the doctor's time please?" When patients see drug reps in the office they generally think that these nice people are taking up the doctor's time and the conversations leads to longer wait times.

In order to address this efficiently and minimize patient contact with drug reps, we asked our reps to limit their appearances in our office to 11 a.m. to 12p.m. and
4 p.m. to 5 p.m.; these two time blocks have the least number of patients waiting and has been well received by even the reps themselves. If the reps must speak to me, we simply ask them to schedule a luncheon for the office and I am happy to listen to their commercial during my lunch time.

My office staff has been instructed to not get me out of a patient room unless there is an actual emergency in progress (active hemorrhaging, labor, etc) or perhaps another physician has called to speak to me regarding one of my patients. My cell phone stays on my desk in my private office and my pager is silenced. In return, we ask our patients to either turn off or silence their cell phones as well. I always walk in to each exam room on time, provided the patient is on time, and I do my best to remove all other distractions outside the exam room during each encounter. Being on time will score tremendous satisfaction points with your patients.

I cannot stress this next recommendation enough. It is very important to frequently call the people/places that frequently call you. It was not uncommon at all for the nurses on the hospital wards to page me several times in the morning and afternoon with question after question. Worse than that, our local nursing home would page me so many times during the day that I would have to leave my pager with my nurse.

In order to effectively handle both situations, I have found it very useful for my nurse to call both the hospital wards and the nursing home wards at least twice each morning and twice each afternoon. During her call, she can take several questions or concerns from the nurses and I can answer them in batches. It has greatly comforted the nurses to know that my office will be calling them. This saves me at least four to five interruptions each morning and again each afternoon.

We also ask any patient who wishes to speak to myself or one of the nurse practitioners regarding a medication problem or other concern to please schedule an appointment. If the concern is too complicated or if they would rather not leave a message with the nurse, it is then worthy of an office visit so that the problem can be accurately documented and taken care of. The patients have welcomed this procedure with open arms.

Of course none of us will ever be able to completely remove distractions or interruptions from our daily practice. By addressing the most frequent work flow distractions proactively, we can at least minimize the number and shift our attention to these daily distractions at times during the day when patient care will not be compromised.

Find out more about J. Scott Litton and our other Practice Notes bloggers.

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