Preparation best antidote to inefficiency

November 1, 2005

Teach your staff the mantra: If you can predict it, you can manage it.

Although you may be instructing staff to perform these duties instead of looking yourself, the process takes them away from helping you. What you need eventually is found. But the inefficiency associated with looking is wasted time.

Unfortunately for you, the American Medical Association has yet to approve a CPT code for looking for a test result, a supply or a form. Instead of being frustrated, take the time to alleviate the challenges that are negatively impacting your efficiency and your bottom line.

Require your staff to review a patient's charts one or two days before that patient's arrival.

The chart should be reviewed for results of tests that you ordered at the patient's previous appointment, reports from any specialists or ancillary providers to which you referred the patient, and documentation from your previous encounter with the patient.

To assist your staff, summarize your orders in the final one or two lines of your documentation of every visit. Your clinical assistant will know where to look to identify your orders - and thus, can make sure that they're back.

Forewarned is forearmed

Instruct staff about the resources available to find missing items, such as the computer interfaced with the hospital, and when you want to be notified of a missing item.

For example, if you're missing a biopsy result for Ms. Jones, it's better to learn that the specimen was lost before Ms. Jones presents, rather than finding out about the problem when she's sitting in an exam room ready to hear the results from you. You can call her beforehand and use the encounter to obtain another specimen. If the results can't be obtained for another week, reschedule now instead of having to walk into an exam room to explain to Ms. Jones that she'll need to return in a week. It's never ideal to have situations like these happen, but being prepared for them improves your ability to manage them.

This process of chart preparation should occur whether your charts are electronic or on paper. It's not about the format of the charts; it's about making sure that you have what you need to be ready when you walk through that exam room door.

Clinic prep

Establish twice-daily protocols (morning and afternoon) for clinical assistants to round your exam rooms.

Protocols should include evaluating the stocks of forms, supplies, equipment and sample medications, as well as cleanliness.

A great tip for equipment is to either hang a designated hook for each piece, or draw an outline of each piece with black marker in a drawer. Staff can quickly scan for missing equipment.

For a simple inventory management system which is effective during a busy clinic, take pictures of common supplies. For supplies maintained in each exam room, print enough pictures for each room. Mark the room on the picture, such as "Room 1". Place a picture of the supply above the bottom two supplies. Staff who uncover the picture during clinic bring it to a designated area and can easily identify which supplies need restocking and in what rooms, without having to walk in every room and look at every supply.

Define your expectations in writing. Decide what you want the rooms to have in them when you walk in, then write it down as a protocol.

For example, do you like to write notes on a personalized pad of paper? If so, make sure that every room has a pad and several pens ready for you. If you have an electronic medical record, record your expectation that the computer should be turned on.