Addressing Walk Ins in Primary Care

[foodlovernurse]

I work as an RN in a primary care clinic/FQHC in the Pacific Northwest. We get a fair number of walk in patients, the majority of whom are presenting for non-urgent lab results (instead of just calling us back).

How do you address these? 

I often have more urgent calls/triages to address and inform the front desk that is the case and that we will call them back as soon as we're able.

Am I the a**hole nurse for prioritizing more urgent cases/calls and not seeing them when they present to clinic?

I feel conflicted about this and appreciate your input.

[canoehead, BSN, RN]

That makes sense to me. they get their results slightly sooner than if they waited for the phone call, and you get your prioritized work done before you look up their chart. I'd add "It could be hours, but you are welcome to wait" to that spiel.

[Tenebrae, BSN, RN]

We'll tell patients 'no news is good news'. In other words if they come back NAD we won't be calling you

If they present make it very clear they will be seen in accordance to their triage level

[CrunchRN, ADN, RN]

No news is not good news. Many missed diagnosis situations because of that. No news may mean the office never got any results etc.....

I would have the front office let them know you will not be able to see them now, but if they leave their contact info you will get back to them when you can.

[JKL33]

Tenebrae said:

We'll tell patients 'no news is good news'. In other words if they come back NAD we won't be calling you

That is an unsafe policy/practice. I do exact opposite-- " I should have your results back [within X time frame]; if you have not heard back about them by [end of general time frame] please go ahead and call the office so that we can look into it and make sure you get them. This is for primarily the patient's benefit but also the provider's; big trouble all around if a critical or seriously abnormal result is overlooked or not received at all. Encouraging the patient that it's okay to follow-up if they haven't heard anything is first and foremost a safety measure IMO.

 

Tenebrae said:

We'll tell patients 'no news is good news'. In other words if they come back NAD we won't be calling you

That is an unsafe policy/practice. I do exact opposite-- " I should have your results back [within X time frame]; if you have not heard back about them by [end of general time frame] please go ahead and call the office so that we can look into it and make sure you get them." This is for primarily the patient's benefit but also the provider's; big trouble all around if a critical or seriously abnormal result is overlooked or not received at all. Encouraging the patient that it's okay to follow-up if they haven't heard anything is first and foremost a safety measure IMO.

[JKL33]

(sorry about the double reply above; something's different about the edit function lately)

[JKL33]

In regard to the OP question I agree with having the front desk let them know that you can see them as your task list allows if they want wait, or that you will give them a call with the results within the next [general time frame]

[Tenebrae, BSN, RN]

JKL33 said:

That is an unsafe policy/practice. I do exact opposite-- " I should have your results back [within X time frame]; if you have not heard back about them by [end of general time frame] please go ahead and call the office so that we can look into it and make sure you get them." This is for primarily the patient's benefit but also the provider's; big trouble all around if a critical or seriously abnormal result is overlooked or not received at all. Encouraging the patient that it's okay to follow-up if they haven't heard anything is first and foremost a safety measure IMO.

In your opinion. 

The people who need the healthcare, get it because all results are gone through, the people with abnormal results are scheduled for further testing or what ever follow up is indicated. Of course, if people want to ring up to find the normal results from their test they are not denied that information. 

And if we want to talk health outcomes, NZ rates high, the US doesnt. 

[JKL33]

Tenebrae said:

In your opinion. 

The people who need the healthcare, get it because all results are gone through, the people with abnormal results are scheduled for further testing or what ever follow up is indicated. Of course, if people want to ring up to find the normal results from their test they are not denied that information. 

And if we want to talk health outcomes, NZ rates high, the US doesnt. 

NZ is not the only place in the world where health care providers endeavor to do the bolded portion above. It sounds like this may be very hard for you to believe, but even in the US providers strive to do EXACTLY what you describe.

You are literally describing that your process does not close the loop with the patient.  I don't know what people in NZ believe about that, but in the US we are generally taught that closed loop communication is a better/safer process.  It makes complete sense to me but it sounds like you're not interested in pondering that idea so I guess I'll just say I am envious  if human processes in NZ are able to be done perfectly 100% of the time.