Need for restructure of Family Practice office

[Barbie Lou]

We have a unique office practice. There are 12 RN's and LPN's and no MA's. Some of these nurses are part-time.This rural practice is about 25,000 patients with 7 physicians, 5 residents and 1 NP. We work with dedicated physicians and a top quality office manager. My question is regarding the need for an office overhaul. 1) Nurses complain about all the phone calls and interruptions with the phone. 2) Receptionists transfer phone to available nurse. Many times there are 2-3 people waiting to talk with the nurse as she is trying to write scripts and set up appointments etc. and dismiss the current patient and also have the rooms filled with the next patients. Patients expect the results of labs and x-rays before they are seen by the physician. 3) On many days this format of one provider and one nurse works well, except on days when one nurse has two doctors and the phone.

Many of you have much more experience than I, so need your advice on how to re-structure our practice. What works for you?

[txspadequeenRN, BSN, RN]

Hello ,

This is nothing I am a expert on for sure but I worked in a OB/GYN office for about 4 years as a nurse and we had a team of RN's that did nothing but triage, see patients for injections, get lab/xray results and IV's. This left the nurses working with the Doc's to concentrate on getting patients in and ready for the doctor. This worked out great for us. Good luck to you hope you get some great ideas...

[Barbie Lou]

Good luck with the bun in the oven. We have a staff member preparing for her 10th.

[mirishrn]

Our receceptionists are trained not to transfer any calls to the nurses unless it's an emergency. If the call is transfered without a chart, the RN is instructed to transfer the call back to the front desk for them to address,(after explaining to the pt the difficulty of addressing their complaint without a chart) Each phone call is documented on a specific telephone encounter with all pertinent pt's info and complaints by the receptionist; then placed in the triage box for the RN to address according to urgency. Hope this help.

[Barbie Lou]

Thanks for your response. I have questions regarding the number of providers and nurses. What is the ratio that is maintained daily?

[anticoagulationurse]

OUr clinic went through a similar overhaul a couple of years ago. It used to be every nurse did everything everyday. Now, as mentioned above, we have nursing positions. Daily we have 2 triage nurses chained to the phones. The receptionist takes a message and the triage nurse (each one has 5 providers whose patients they triage) prioritizes the calls. ONLY in suspected emergencies does a call get placed directly to the triage nurse. The receptionist gets key words to look for like, chest pain , abdominal pain or numbness, etc. The triage nurse book sthe same day appts. We save 2-4 same day appts per provider. They are always used up.

Also, there are 2 Float nurses at all times (one for each team of 5 providers) who work the paper chase, refills, misc nurse support, nurse visits, walk-ins, relieve for lunch breaks, etc.

And then there is the Primary nurse who may delegate at any time a duty to the float nurse. THis really keeps the flow going, no problems. Each nurse is interchangeable no matter what the task du jour. Although, usually primary nurses stick with that, they can fill in other dutes on provider days off.

There is a similar system for the front office staff. Each staffer can do Phones, Patient check in, Checkout, Referral appointments, etc. and they rotate too.

Ratio is weird: Let's see 10 providers. If they all worked on the same day, that would be 10 primary nurses (but usually 5-6 providers daily- point is, each provider has one nurse). 2 triage nurses daily, no matter how many providers are working htat day, 2 float nurses daily. So in addition to primary nurses, there are 4 support nurses. I bet it's expensive, but it sure works for us.

[reneemcsquared]

I agree that training secretaries to only transfer urgent calls to nurse is important. I have seen great success with systems where the secretaries take calls (prescription refills, request for home care, lab results, etc) and take all information, ask patient "is it alright if nurse calls you back in two hours" gets information for call back, and leaves message for nurse to triage her call backs. If patient says not alright, nurse comes on phone. much more cost effective to have more secretaries so nurses can do nursing functions.