Beginning the Day Care Transformation Collaborative of R.I.

1. Beginning the DayCare Transformation Collaborative of R.I. Best Practice SharingMay 5, 2015 Karen sciamacco, rn, bs, ccm, cdoe Associates in primary care Medicine

2. Starting the Day • My day starts with a good cup of coffee • Before I get to the office I: • Check the appointments that scheduled for me • Check the appointments that are scheduled for the other providers. 2 physicians and 3 nurse care managers. (Looking for any high risk or complex patients that may be scheduled)

3. Starting my day • Looking in my messages to prioritize: • Any urgent referrals. • Any patients discharged from the hospital or the emergency room. • Any patients discharged from another setting such as a nursing home, rehabilitation, or other setting. Transition of care • Responses from the providers

4. Beginning the Day: The Lists • Being successful is accessing the lists! • No day is complete without reviewing the lists • Stratified lists from the insurers with high risk patients • Complex patient lists: Vunerable patients, chronic disease patients • Keeping track of high utilization patients. Those with frequent ER and hospital visits.

5. Beginning the Day: The Lists continued • Other lists to consider • Outliers: Patients with a chronic condition that do no have: • A follow up appointment with a provider scheduled • Patients with ordered labs that are not completed • Those with blood pressure or blood sugar logs that are due

6. Beginning the day with a plan • Benjamin Franklin supposedly once said, “If you fail to plan, you are planning to fail.” • Inevitable there are those days where your plan maybe over taken by other things. • Being called to meet with a patient whom was not on your schedule. • Unexpected phone call that requires action • In those cases you just need to adjust! • And tomorrow is a new day!

7. Thank you Any Questions?? If I can help, please give me a call!401-467-3115