Interactive Clinic Systems Case

This case takes you through a patient encounter to think about the workflow in clinic. When you see a bolded clinical staff area, look below at the clinical staff check list to discuss what they do (or you can discuss the case first and review the clinical staff areas after).

The RN sends you a triage message under telephone encounters saying that a patient of yours, a 55 year old man with type 2 diabetes, is calling with an open wound on his foot.

-What should you do?

The patient was scheduled to see you in 1 week for a 3-month diabetes follow-up, so you communicate with the triage RN that you want to see him today instead. You huddle with the MA/LPN you are working with for the half day before your patient encounter starts.

-What types of things should you discuss in the huddle?

It’s time to start your clinic half day. This patient is first on your schedule. You go into the exam room and start the encounter. When reviewing his chart and vitals, you see his blood pressure is 150/90 and realize it has been this high for 1 year. He has a mild open sore on his foot that is not painful. He has no fever. He does not have a diagnosis of hypertension and is not on any blood pressure medications. You are considering starting lisinopril for hypertension.

-How do you order a medication for the patient?

-How do you update the problem list to indicate a new diagnosis of hypertension?

-Does your clinic have a pharmacist, and if so, how would you enroll him in the pharmacist hypertension management protocol?

You go to staff the encounter with the staffing physician.

-How does the staffing process work?

The staffer sees the patient with you, and you determine that the patient needs to get a basic metabolic panel (BMP) lab checked due to starting lisinopril and get an x-ray of his foot to rule out osteomyelitis.

-How do you order a lab and what process does your clinic use to send a patient to lab?

-How do you order an x-ray and what process does your clinic use to send a patient to x-ray?

After the x-ray, the patient returns to the exam room to review the results. You call the on-call radiologist and confirm there are no signs of osteomyelitis, and based on the clinical picture you decide not to get an MRI. As you are wrapping up, the patient mentions that he has recently lost his job and will lose his insurance in a month and is feeling depressed. He is not interested in medication but is open to other treatments.

-Where do you find a PHQ-9 depression screening form? You can’t find one in the exam room. How could you ask your MA where it is without leaving the exam room?

-What behavioral health services do you have at your clinic? How can you refer to additional services?

-What social work resources/referrals can you offer to this patient regarding financial and insurance resources?

To wrap up the visit you decide to refer the patient to podiatry for foot care and ophthalmology for a yearly eye exam. You also want him to follow-up in 2 weeks for a blood pressure check with an MA and for a repeat BMP.

-How do you order referrals/consults?

-How do you type patient instructions?

-How do you indicate to the reception staff (PSR) regarding patient follow-up?

-How do you enter the level of service and diagnoses?