Question Regarding How Nurses work with Dr's

[4jen]

I work in a cardiology office and we have been tasked to reorganizing the way we run the office. We have anywhere from 2-3 nurses and sometimes a tech. We have anywhere between 1 provider and 3. We have 9 rooms.

Our Dr's are not happy with the front desk, us or the process. Okay let me restate this: none of us are happy and nothing is working.

I am looking for feedback regarding how any of you handle a day.

We have considered one nurse for each DR and actually attempting to sit with them.

Having just an intake nurse and discharge nurse for each day.

Or doing what we have been doing which is whatever it takes. We mostly try to keep to one Dr however it doesn't always work.

Our issues are related to not having past medical records for appts. Appoinments regardless of pt follow through meaning pt should have had labs or echo and did not. Dr's not communicating return appts clearly. Process held up because pt did not bring meds nor do they know their med (urban, safety net hospital). Triage and med requests.

Any feed back would be so appreciated.

[groovetta]

I work for surgeons rather than cardiologists, but it is my job to prepare for pt. appts. being sure that the patient's test results, surgical path reports, etc. are on the charts for their for post-op or follow up appts. On new pts. we will often need to have their CT, heart cath films, etc. in hand at their initial office visit. We try to be sure that if the pt. needs to bring their films with them, we tell them when the appt. is made (it took me a long time to get this one to where it happens regularly). Most time we can get the films online, but if done at distant facilities, we have to ask the pt. to bring the films with them. For a long time, our front office person would schedule tests not making note of who would be performing the test and giving patients follow up appts. when their tests results were back yet, etc. This was a big mess for a while, but we worked it out by changing making sure the schedule test was documented in a designated place in the pt's chart, and then basically who would be responsible to do what. Things are running smoothly now. : )

Our office from what I can tell probably isn't quite like a cardiologist office though.

In the cardiologist office that refers pts to us, they recently got computers Cows- computers on wheels that one nurse goes into the exam room with the doctor and types into the computer while the doc examines the pt. I think they have a nurse for each cardiologist. From what I can tell just from having cardiologist refer to us, that cardiologist offices are very busy and usually have a lot of docs and staff. I think the best thing you could do is to be sure everyone knows who is responsible to see each task is done and a time frame to get it done. IMO, a procedure book would be good to have, but it would have to be updated from time to time as things may change as to how they are done. I would suggest making each task as simple as possible and with the least steps possible.

[groovetta]

Our issues are related to not having past medical records for appts.

If they are your own office's records, I'd think they should be in the patient chart whether a paper chart, an old paper chart scanned into a computer and retrieivable, electronic medical record, or whatever your office uses. If you're referring to records from referring physician's, our office has a sheet we fax over to the referring physician's office requesting a list of info such as demographics, ins. info, test results, H&P, clinic notes,etc. We automatically fax this as you can't always depend on the caller to remember to fax you the records. I personally prefer to have the records fax ahead of time rather than the records being sent with the patient. We keep a folder "new pt." with the sheet we faxed to req. med. records until we get the records. If we haven't gotten the records at least the day prior to the appt. we start calling asking for them over the phone.

Appoinments regardless of pt follow through meaning pt should have had labs or echo and did not.

We've had this problem too. We had one doc who did the non invasive surg. for afib which required about three tests done in the cardiology office. This was the biggest nightmare for a while because the pt. would show upfor their appt. with us and the test results weren't ready yet. I created a check list for this one that included the test, date and time, location where it was to be done, a blank indicating when and who informed the pt. of the test, and also when the follow up appt. would be and a check box for if the results were on the pt's chart. This was the only thing that kept us all organized. We could refer to this check list page that was kept in a certain place on the chart and regardless if you weren't in the office that day, anyone could pick up the chart and know what was ordered, where the test was going to be done, if the pt. was aware and when the F/U appt. would be, and if we had rec'd the results. It did become my responsibility as the nurse to be sure all needed items were on the chart for the pts appt. The one doing the scheduling had to do their part with the checklist though, but if that was done it wasn't too difficult from that point being sure we had everything we needed when the pt. came in for their appt. I could email you the check list(s) and you could adapt them to your practice if you'd like.

Dr's not communicating return appts clearly.

I'd just ask the doc, now when did you want this pt to return for a noffice visit, maybe asking in front of the patient until you got the doctor trained and he automatically tell you. :-P

Process held up because pt did not bring meds nor do they know their med (urban, safety net hospital). Triage and med requests.

I know what you mean because I sometimes will be told, "I take a high blood pill, a sugar pill, or a little yellow pill." I think like training the docs to communicate follow up appts., you may have to train the pt's to keep a list of medications in their wallets or purses (our patients are pretty good to do so). The cardiologists that refer to us have a home medication list sheet on their website that the patient can use to list their meds and bring to each doctors visit.

[4jen]

Thanks so much. That really helped. :)