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Purpose
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To
establish a standard practice for sending and receiving faxes at Pinchot
Family Medicine.
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Scope
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This work
instruction shall apply to all persons sending and receiving faxes at the
Pinchot Family Medicine front desk.
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Materials and Equipment
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Windows Live Mail
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Process
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Open the Windows Live Mail program by clicking
the shortcut icon.
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Select the email account for “Pinchot Fax.”
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To send a fax, click the button labeled “Email
Message”.
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In the “To” bar, type the fax number including
a one, the area code and number without any spaces or dashes. Finish with “@efaxsend.com”.
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Type a coversheet that includes who the fax is
being sent to, the office name, phone number, fax number, the date and the
number of pages in the fax including the coversheet.
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Click the tab labeled “Insert” then the button
labeled “Attach file” at the top of the message.
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Select the file you wish to send, and click
“Open”.
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To receive a fax, look in the Pinchot Fax
inbox.
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Faxes come in attached to an email.
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On the email, double click the attachment.
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Print or save the fax to the appropriate
document folder.
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Timing
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This section used to
acknowledge completion of training – place orginal signed document in employee’s
personnel file
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Employee Signature
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Supervisor Signature
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Name:
Date:
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Name:
Date:
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Saturday, August 23, 2014
Standard process for sending and receiving faxes
Standard process for processing telephone messages
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Purpose
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To establish a standard practice for processing telephone
messages at Pinchot Family Medicine
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Scope
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This work instruction shall apply to all persons answering
the Pinchot Family Medicine telephone at the front desk.
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Materials and Equipment
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Phone
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Oxbow EMR
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Process
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When a patient calls for a prescription refill
or would like clinical advice from Dr. Moyer, search for them in the Oxbow EMR. For more information pertaining to logging
into the Oxbow EMR, see CT-WI-001.
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Click “Search” and type in their name.
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Click on their name to open up their Oxbow
chart.
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Click the “Patient Requests” heading and
select “New Request.”
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Choose the appropriate type of request and
select the appropriate recipient.
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Type the message in the “Comment”
section. Phone messages shall always
include the patient’s call back number and the nature of the call.
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If the message is a follow up call concerning
a medication or the patient is experiencing a side effect, the message shall
include the name of the medication.
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If the message is for a prescription refill,
include the name of the medication, how many days the refill should cover
(i.e. a 30 day or 90 day refill) and which pharmacy the patient prefers to
use.
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On the encounter, click “Apply.”
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All calls received during office hours shall
be answered and returned within four hours.
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Calls received after-hours shall be answered
within the first four office hours of the next business day.
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Timing
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This
section not used on this work instruction
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This
section not used on this work instruction
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This section used to
acknowledge completion of training – place orginal signed document in
employee’s personnel file
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Employee Signature
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Supervisor Signature
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Name:
Date:
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Name:
Date:
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One page Medical Practice Emergency Clinical Protocols
OFFICE EMERGENCY PROTOCOLS
1.
Cardiopulmonary Arrest
a)
Begin Basic Life Support
b)
Call 911
c)
AED
2.
Chest Pain
a)
Obtain EKG and include O2 saturation with vitals
b)
Contact 911 for transport
c)
Begin supplemental oxygen at 2L
d)
Administer aspirin 325 mg chewed
e)
Consider sublingual nitroglycerin
3.
Respiratory Distress
a)
Obtain respiratory rate and pulse oximetry
b)
Consider use of supplemental oxygen at 2L
c)
Consider nebulized Albuterol and/or Duoneb, up
to 3 treatments
d)
Consider administering IM steroid if not
significantly improved after one nebulizer treatment
e)
Consider 911 for transport
4.
Anaphylaxis
a)
Epinephrine:
attempt to administer near site of initial insult
i.
Adult or child 12 years or older…………….0.3 mL to
0.5 mL IM
ii.
Child 5-12 years old………………………...0.3 mL IM
iii.
Child 2-5 years old………………………….0.2 mL IM
iv.
Child 0-2 years old………………………….0.1 mL IM
b)
Benadryl:
for urticaria, itching, angioedema
i.
Adult or child 12 years of older……………..50-100 mg
po or IM
ii.
Child 6-11 years old…………………………12.5-50 mg po or
IM
iii.
Child 2-5 years old……………………1.5mg/kg per dose po
or IM
c)
IM Steroids:
consider use to prevent delayed reaction
d)
Nebulized Albuterol: consider if significant bronchospasm
e)
After stabilization: 911 transport to ER for observation
5.
Stroke: 911 transport immediatelty
6.
Poisoning
or envenomation: contact poison
control 1-800-222-1222
7.
Trauma: stabilize and transport
8.
Eye
exposure: consider eye wash and
specialist or ER evaluation
9.
Status
epilepticus: 911 for EMS
administration of Diazepam
10.
Altered
Mental Status: obtain O2 saturation
and fingerstick glucose
11.
Hypoglycemia:
a)
Patient awake/cooperative: administer oral sugar-containing food or
beverage
b)
Unable to take oral:
i.
Adult:
1-2 mg Glucagon IM or SC
ii.
Children:
0.025-0.1 mg/kg Glucagon IM or SC
Clinical Scenarios and Testing Protocols
Clinical Scenarios and Testing Protocols
There are a number of clinical scenarios where it is
predictable that a clinician will need and order a specific point of care
test. Therefore, when rooming the
patient with the following clinical scenario, the staff that is rooming the
patient should perform the appropriate test and record the results in the
Labs/Procedures section of the full encounter note.
1.
Sore
throat, age 4 – 20: obtain quick
strep. A quick strep is not
necessary if the patient has a sore throat and a red rash (scarlet fever), or a
close contact with a recently documented strep infection.
2.
Abdominal
pain, nausea, or vomiting in a female aged 15-45: consider obtaining urine pregnancy test.
3.
UTI or
other urinary symptoms (burning, frequent urination, blood in the urine): obtain a urine dip.
4.
Confusion,
loss of consciousness, or altered mental status: obtain pulse
ox and fingerstick glucose.
5.
Vaginal
discharge:
a)
Patient undressed from the waist down
b)
Prepare room for wet prep swab and GC/Chlamydia
6. Female with acute lower abdominal pain (and
no history of hysterectomy)
a)
Age 12-50:
consider urine pregnancy screen
b)
Patient undressed from the waist down
c)
Prepare room for wet prep swab and GC/Chlamydia
7.
Acute
chest pain: obtain 12-lead EKG and pulse ox.
8.
Palpitations,
new or acute complaint: obtain
12-lead EKG
9.
Tachycardia
(over 110 bpm) or pulse irregularity during vitals, and no obvious cause listed
on the medical history: consider
obtaining 12-lead EKG and a rhythm
strip
10. Dizziness or syncope: standing and lying down pulse and BP
(orthostatics)
11. Worried they may have diabetes: obtain fingerstick glucose
12. Complaints of excessive thirst: obtain fingerstick glucose
The basic math of our practice model
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Assume $70 per visit (which is low)
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Assume each patient per day generates approx.
$17,000 per year
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Traditional practice employs 3.5 to 7 staff per
clinician
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Assume average employee costs practice $40,000
per year
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Assume office expenses $3,000 per month ($36,000
per year)
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Our practice model employs 1-2 staff per
clinician
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Scenario #1, traditional practice; 16 patients
per day; 4 employees
o
Annual Revenue:
$272,000
o
Annual employee costs: $160,000
o
Annual office expenses: $36,000
o
Your take home = Revenue – expenses = $76,000
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Scenario #2, IMP practice; 16 patients per day;
1 employee
o
Annual Revenue:
$272,000
o
Annual employee costs: $40,000
o
Annual office expenses: $36,000
Your take home = Revenue – expenses = $196,000
Written protocols to transform the quality and profitability of any outpatient practice environment
Most of the clinical and business-related processes involved in delivering outpatient medical care are common to all practices.
We have developed detailed written work instructions and clinical protocols that describe all office clinical and business processes. Having written work instructions enables us to standardize the training and knowledge base of each care team member, and results in substantial improvements in staff performance.
It also enabled us to understand our practice processes more clearly, and then to re-work and improve those processes, to the point that we were able to re-define traditional practice staffing, dramatically reducing the number of staff per physician necessary to provide seamless patient care.
We are able to provide longer appointment times than is traditional, while at the same time we have lowered our practice overhead costs so substantially that profitability has soared.
Our work instructions could transform any practice environment.
We have developed detailed written work instructions and clinical protocols that describe all office clinical and business processes. Having written work instructions enables us to standardize the training and knowledge base of each care team member, and results in substantial improvements in staff performance.
It also enabled us to understand our practice processes more clearly, and then to re-work and improve those processes, to the point that we were able to re-define traditional practice staffing, dramatically reducing the number of staff per physician necessary to provide seamless patient care.
We are able to provide longer appointment times than is traditional, while at the same time we have lowered our practice overhead costs so substantially that profitability has soared.
Our work instructions could transform any practice environment.
Most docs we hear from are unhappy...but we're not!
This is the blog of Matthew Hahn, MD and Shawn Moyer, MD. We are both practicing family physicians with small, almost rural practices. We have both been in practice since the early 2000s, a time of great change for medicine...most for the worse.
Over the years, we have developed a number of transformational ideas in regard to the outpatient practice of medicine. We have been part of a small team that has developed a fantastic EMR, the Oxbow EMR. We also began to experiment years back with re-engineering strategies.
We have been able to create a very different type of medical practice...where we take excellent, personalized care of our patients, have well trained/well paid staff, and have a very successful business model.
While we hear an almost constant din of unrest and unhappiness among our colleagues, we are HAPPY!
We are two happy docs!
We have talked about blogging for a long time...to get the word out there to other docs. You can be happy, too.
The common theme that we hear is that docs in independent practices are finding it hard to survive, and thinking that larger employers offer salvation, leave the world of the independents for employed positions. They then find out that large employers have their own set of problems, and they are unhappy in that environment as well.
We would like to share our ideas so that independent practices can again flourish...but we believe that the methods we have developed apply to any practice setting.
Over the years, we have developed a number of transformational ideas in regard to the outpatient practice of medicine. We have been part of a small team that has developed a fantastic EMR, the Oxbow EMR. We also began to experiment years back with re-engineering strategies.
We have been able to create a very different type of medical practice...where we take excellent, personalized care of our patients, have well trained/well paid staff, and have a very successful business model.
While we hear an almost constant din of unrest and unhappiness among our colleagues, we are HAPPY!
We are two happy docs!
We have talked about blogging for a long time...to get the word out there to other docs. You can be happy, too.
The common theme that we hear is that docs in independent practices are finding it hard to survive, and thinking that larger employers offer salvation, leave the world of the independents for employed positions. They then find out that large employers have their own set of problems, and they are unhappy in that environment as well.
We would like to share our ideas so that independent practices can again flourish...but we believe that the methods we have developed apply to any practice setting.
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