Direct Referral Clinic Why, How and Who?

Transcription

1 Direct Referral Clinic Why, How and Who? Macaila C. Eick, RN CNP American Association for Thoracic Surgery Allied Health Personnel Symposium May 4, 2013

2 No Disclosures Objectives Describe the function of a direct referral clinic, what it is and who works there Discuss three reasons a direct referral clinic could be beneficial to your practice Identify how to use a direct referral clinic in your practice 2012 MFMER slide-2

3 What is a Direct Clinic? Initially developed by Colon and Rectal surgery in 2007 Directly refers a patient to a surgeon CV surgery is the 4 th surgical area at Mayo to start a direct clinic Reduces duplication of consults and testing Streamlines process for outside referrals to save time and money MFMER slide-3

4 Who? 1 st : Colorectal Surgery, nd : Thoracic Surgery, rd : GI/General Surgery, th : Cardiac Surgery, th : Plastic Surgery, th : Bariatric Surgery, th : Breast Surgery, Coming in future 2012 MFMER slide-4

5 Who works in a Direct clinic? Nurse Practitioner or Physician Assistant Work with patient appointment coordinators (PAC s) and secretarial staff Clinic staff RN Desk staff Medical assistants 2012 MFMER slide-5

6 Direct Clinic 2012 MFMER slide-6

7 Who? 10 Cardiovascular Surgeons at Mayo 2012 MFMER slide-7

8 Why? Direct referral route for an outside cardiologist to send their patients to CV surgery Reduce duplication of testing and clinic visits Efficiency Patients Surgeons 2012 MFMER slide-8

9 Why? 2012 MFMER slide-9

10 Why? Reduce duplication = less cost New patient cardiology consult = $ EKG = $146 Chest x ray = $159 TTE = $ CBC = $68 Electrolytes = $ Phlebotomy charge $26 From Mayo estimating department 9/ MFMER slide-10

11 Why? Become more efficient Surgical volumes are increasing 2013 goal is to reach 3,000 CVS cases Allows surgeon to be more efficient with the patient visit Leading to ability to see more new patients 2012 MFMER slide-11

12 Case Study #1 54 y.o. man referred for HOCM and myectomy. Preoperative lab work on the day of consult revealed new microcytic anemia Hemocult ordered and came back + Referred back to LMD for GI work up prior to surgery 2012 MFMER slide-12

13 Case Study #2 72 y.o woman referred for MV repair r/t MV regurgitation PMH: Included diverticulitis. Preoperative consult revealed recent flare with ongoing bleeding. Referred back to her GI doctor for evaluation and treatment prior to CVS 2012 MFMER slide-13

14 Case Study #3 74 y.o man referred for AS and CAD Outside record review documents new pulmonary nodule and referral to a local pulmonologist CVS requested additional records. Found to have biopsy and PET scan documenting lung CA. Concurrent consult arranged with thoracic and cardiac surgery when came to Mayo 2012 MFMER slide-14

15 Case Study #3 (continued) Day of Mayo consult included lab work Hemoglobin 7.5, new finding Admitted to cardiology for further evaluation of new anemia in setting of severe AS GI work up found GI bleed Surgery postponed until worked up further 2012 MFMER slide-15

16 Case Study #4 52 y.o woman seen in direct clinic preop Underwent successful AVR for AS Dismissed home and came back for routine follow up Follow up revealed new Afib with RVR Symptomatic Consulted with cardiology via phone and sent to ER 2012 MFMER slide-16

17 Case Study #5 65 y.o. man seen for follow up after recent dismissal Status post MV repair Exam revealed decreased breath sounds. Chest x-ray revealed increased right pleural effusion Referred for thoracentesis 2012 MFMER slide-17

18 How? Institutional support Surgeon support Other NP/PA support Office and clerical support Clinic space and support Ongoing communication and adaptability is important 2012 MFMER slide-18

19 How? CV surgery appointment phone for referring providers # Appropriate preoperative information shared with CVS. Information reviewed by MD/NP prior to patient arriving to Rochester MFMER slide-19

20 Mayo Clinic Locations 2012 MFMER slide-20

21 2012 MFMER slide-21

22 Questions & Discussion 2012 MFMER slide-22