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Agenda. Announcements Letters from patients Specialty Clinic referrals Ancillary referrals Nurse interventions. Welcome Carolyn Crank. Congratulations to Sara Malone. Congratulations to Johnnie Satterfield.
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Agenda • Announcements • Letters from patients • Specialty Clinic referrals • Ancillary referrals • Nurse interventions
Congratulations to Johnnie Satterfield • Selected as one of this year’s At Large PlusPeople. This honor is presented to UNC Hospitals employees for their outstanding performance and service on the job. • The At Large PlusPeople Awards were established to recognize people who consistently excel at their jobs and who demonstrate an enthusiasm and devotion to duty that inspires others. Your selection for this honor is a tribute to the positive attitude you bring to your job, the high quality of your work and your concern for all the people we serve.
Letter of Appreciation Edna, I wanted to let you know how much I have appreciated your staff in the Internal Medicine Clinic this past year. I have basically had to get blood drawn at least every 3 weeks for the past year. I have been so lucky to have Dr. Greganti in charge of my care. I want to give an extra special thanks to Mrs. Satterfield and Marilyn. They were the ones who I usually dealt with when I needed my blood drawn. It was so nice to always be greeted with a smile when I showed up at the desk to get my lab slip. I have worked as a nurse in the outpatient clinics at UNC for a long time and having efficient staff members is so important. I want to thank you and your staff for making the past year much easier for me. I know we don't always hear about positive things and I wanted to make sure that I let you know how much I have appreciated everyones kindness this past year. Thank you to everyone! Name withheld
Letter of Appreciation Thanks for seeing me for my annual check-up. My visit on Thursday was the most efficient of any I have had in 25 years of seeking medical care at UNC. The personnel at the desk were smiling, polite, and respectful. The nurse (I failed to write down her name) was exceedingly pleasant and helpful. And there was no unnecessary waiting or delay. Name withheld
Letter of Appreciation To: BILL ROPER Subject: Re: Sometime the system works as it is intended !! Dear Bill, As the recipient of all the problems and misadventures that occur within UNC Health Care .... I would like to report a recent personal experience at UNC hospitals (ACC) that indicates that the system does work ... and nicely illustrates that UNC Health Care ... "is for and by the people of North Carolina“ .... even as we approached a major holiday. The Problem and the Resolution .... My brother and his wife (name withheld) were visiting for the Thanksgiving holiday and while (name withheld) was not feeling well on Tuesday upon arriving from Princeton by Wednesday morning a rash was on her abdomen and she was in great pain. We suspected Shingles ... and this clearly needed medical attention. I called Amy, the appts person for Internal Medicine, and asked who was the attending physician in the Same Day Clinic ... and as luck would have it ... the attending was Russ Harris. I asked to speak with Russ and explained the situation and since (name withheld) was not a patient of any Internal Medicine physician he proceeded to check with the "front desk“ ... and the decision was that we should come to clinic. At the clinic desk Rob Hartman and Laura Hutchins, the admitting clerks, asked if (name withheld) had ever been a patient at UNC .... and she indicated that not to her recollection but that she was a physical therapist at UNC Hospital in 1966. Ms.Hutchen asked (name withheld) her maiden name, searched the UNC data base and to our surprise located her record. Evidentally UNC policy requires that all hosptial employees are registered and this data is maintained over time. Ms Hutchins registerd (name withheld) as a new patient, we proceeded to the exam room and seen by the the triage nurse, the resident and Russ. It was indeed Shingles, medicine was prescribed ... and while some discomfort remained it was manageable throughout the remainder of their visit. Obviously we were fortunate to have a personal relationship with Dr. Harris, but most important is that all the personnel involved permitted the system to meet the needs of the patient and her family. To a person all were knowledgable, gracious and accommodating to our needs, for which we are most grateful. Hope you and yours had a wonderful thanksgiving holiday ..... and thanks to all those mentioned above ... so did we .... All the best Name withheld
Specialty Clinic Referrals AKA: “The Blue Sheets”
How many referrals do we do? • 650-700 referrals/ month
Three different pathways • Patients must call for own appointment • Internal Medicine can schedule appointment for patient • Appointment goes under review by the specialty department physician who decides if appointment can be scheduled
Clinics where patients must call to schedule their own appointment:
Clinics that require referrals to go under physician review: • General Surgery • GI/ Hepatology • Plastic Surgery • Podiatry • Rheumatology • Urology • Specialty Neurology Clinics * Scheduling process can take up to 2 weeks
Self Pay Patient No notes posted in WebCis regarding referral reason. Internal Medicine physician is not listed as the PCP on the patients insurance card. Patient must set up payment arrangements with Financial Counselor. Clinic will deny referral request during physician review process. Authorization will be denied by patients insurance company. - Aetna - Cigna - Partners Medicare - Tricare Prime - Mamsi - Carolina Access Top 3 reasons why appointment referral request are not scheduled:
Priority tracking Internal Medicine Clinic Referral Form Patient: ____________________________________ MR# ____________________________________ Date: ____________________________________ Referring MD: ____________________________________ Attending MD: ____________________________________ Referring MD Signature: ________________________________________ 1Referring to: Clinic_________________ Doctor _________________ New to referred clinic When: Routine within _________________________ Return to referred clinic Dx/Symptoms: __________________________________________________ Date of Onset: _____________ Reason for Referral: ______________________________________________________________________________ __________________________________________________________________________________________________ Priority referral; needs tracking See WebCIS Note. Note Date: ___________________
Priority Referrals • Designed to indicate if provider wants to track the referral process for a particular appointment • If you mark the priority referral box on blue sheet, then a WebCIS message will be sent to you when appointment has been scheduled • Keep in mind, the following can happen at various stages: • Patient given number and told to call • Specialty physician is reviewing the case • Financial arrangements need to be made
Comments? Suggestions? • There is no universal referral form for UNC • No current electronic referral system
Ancillary Scheduling • Universal order form
The Process • Physician fills out the order form and gives it to the patient • Patient carries form to front desk • CBA calls for appt with patient waiting
Scheduling Protocol • Call and schedule with patient present • Effective 95% of the time – takes 5-7 min • Exceptions • CBA at lunch • No answer • These appts made later in the day or the following morning • Patients called for near appts • Others mailed
Scheduling Protocol (continued) • Fax requisition • File • Copy of requisition – kept for 3 months • Confirmation of fax receipt (separate file) • Radiology may deny receipt of fax • Original goes to Med Records
Pending – GI procedures • Requires patient confirmation to schedule • Other services allow scheduling with subsequent patient notification • Procedure • Fax requisition to GI • GI calls patient • GI faxes confirmation of appt to IM Clinic • File kept until circle closed • 2 currently in file • Failures • GI tries 3 calls over 30 days and then gives up • Patient declines • Changes mind – may happen at any time • Financial intimidation • Doctor notified with webcis message
Tracking Files are maintained at each of the front desk areas for ancillary requests. Each of the folders are divided into headings: GI, CT, MR, Echo, etc. • Complete. These include ancillary appointments scheduled in real time as well as those completed later. • Pending. This folder contains all request forms that are delayed for any reason. (Primarily GI procedures) A master file is maintained by date of service for all completed ancillaries for at least a 3 month period. These are filed at the West Wing front desk by Kelly Gillison; East Wing by Yvette McCollum.
Scheduling problems • Incomplete and illegible forms • No physician code # • No signature – may require wait until next clinic • No diagnosis – page or interrupt doctor • No ICD code for echo – page or interrupt doctor, or try coding • Patient changes mind • Meeting with financial counselor required
Nurse roles in patient care:management of patients with diabetes
Nurses are valuable part of the care team • Nurses are the first point of clinical contact • Nurses can identify issues that need to be addressed before the provider enters the room • Many of these issues can be addressed without directly involving the physician • Nurses bring a unique perspective to patient assessment • Nurses can improve the quality of care provided • Nurses can improve patient satisfaction • Nurses can help connect patients with care assistants when they need help
