An interprofessional model of care in rheumatology - new patient appointments

Dr. Michelle Teo Duration: 5:59

Hi, I’m Dr. Michelle Teo, a community rheumatologist in Penticton British Columbia. I’d like to introduce you to an interprofessional nursing model of care in rheumatology. This model of care involves working along side allied health professionals, such as nurses, physio or occupational therapists, so that as the clinician, you can focus your time and energy on what you were trained to do; treat, diagnose and problem solve, while providing high quality patient care. This video will show you how I use this model, but you can adapt it to your personal preferences, which can be influenced by your office space, number of staff you wish to employ, patient demand, digital technology savviness, and comfort with delegation.

In this video I’ll cover an interprofessional nursing model of care specifically for a new patient appointment referred for inflammatory arthritis and will show you the steps involved.

First of all, it’s important to understand the touch points that take place prior to a patient appointment. All of these steps are what help create improved efficiencies and opportunities for the patient to provide a complete and accurate history.

This model of care begins when the nurse first receives the patient referral. The referral acknowledgment is sent back to the GP as soon as possible.

The MOA will initiate the very first touch point and calls the patient to pick up a patient background form and any required medical/legal forms, such as permission to email the patient, use of videomedicine, and the no show policy.

The patient will complete and send back the patient background forms unless they were included with the referral letter. We have recently adapted this process so that the patient can fill these forms out at home a few days prior via email through a secure messaging program.

Once returned, the nurse will review the patients background form and will triage the patient.

Once triaged, the patient will receive a phone interview appointment time and a face to face appointment time scheduled with the nurse and the doctor.

Patients will always receive a text, phone call or email reminding them of their appointments. Keep in mind the cost per patient for this service is much less than the lost revenue for no show patients and your MOA’s time.

The first appointment for the patient is a 20-30 minute appointment over the phone with the nurse. This is an important touchpoint as the nurse is able to ask more detailed questions to the patient regarding history that was provided in the patient background form. This also provides a second opportunity for patients to provide further history if required.

For efficiency, the nurse types out the history with the patient on speaker phone, although much of has likely been prepared ahead of time based on the background form. This is the preferred method compared to having the patient sit in person and type an extensive history, as this can detract attention from the patient.

It is important to note that this is not a billable appointment, but allows me to see twice the number of new patients for billable appointments. Remember that the billable amount for a consult is much less than the cost of an allied health member spending 30 minutes to do a phone history.

The next touch point is the face to face appointment 1-2 weeks later. The same nurse who did the 20-30 min patient interview now sees the patient. This is a third opportunity for patient to add any further details to their history.

It is important that this appointment does not happen too far after the phone interview, as you don’t want the patient’s history to dramatically change from what has already been documented. This part of the appointment rarely take longer than 5 minutes.

At this time the nurse will perform a physical exam. While this is happening, I’ll read the history, review the investigations and subsequently join the nurse and the patient in the room where there’s a diagrammatic representation of the physical exam already performed by the nurse.

The nurse will provide any further information that has been provided by the patient during the appointment. I’ll discuss the diagnosis with the patient and through shared decision making develop suggestions for a treatment plan.

While I am speaking to the patient, the nurse prepares documents for the patient, including handouts about their diagnosis, medications and an individualized list for the patient to take home.

At this point, the nurse will make up a list for the patient while I’m speaking, providing a printed resources for the patient to take home. When the face to face appointment is over, I will then leave the room and immediately dictate my impression and plan while the patient is counselled on medications by the nurse. The rest of the letter has been completed.

Finally, the patient is given a card, which is given to the MOA, to make a follow up appointment, which highlights if it’s in person, virtual, and if injection training is required.

As you can appreciate, having an organized and systemic flow can greatly improve the efficiency of the patient visit. Based on your current office set up, how do you think you can make changes to improve the efficacy of your work flow when seeing new patients?

If you would like to know more about how you can set up a more efficient model of care in your office, please feel free to contact me.

We all know that seeing new patients in consultation can involve a lot of energy and time. I hope this video has been helpful to demonstrate the possibilities of increased efficiency in your practice.

Presenter: Ms. Michelle Pavic, Video Sponsor, Dorval, QC

Local Practitioners: Video Sponsor