Добавил:
Sekretar
kiopkiopkiop18@yandex.ru
t.me/Prokururor I Вовсе не секретарь, но почту проверяю
Опубликованный материал нарушает ваши авторские права? Сообщите нам.
Вуз:
Предмет:
Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_3648_Библиотеки_им_академика_М_И_Перельмана
.pdf
20
A. Ellis and T. Wallace
in partnership with the Triage nurse and
involves addressing the patients’ needs, directing the calls elsewhere as needed, prioritizing
the urgency of the message or request, checking the status of pending outpatient surgery
clearances, and coordinating for wound supply orders through the patient’s insurance
company. PSC (B) either speaks with the
Triage Nurse directly throughout the day, or
they communicate through the patient’s EMR
messaging system. PSC (B) is also responsible for collecting and distributing documents
from the fax machines, scheduling follow-up
appointments for our inpatients on their discharge, and scanning urgent documentation
into the EMR system. This position is wellsuited to an associate with previous clinical
experience in the CWH, as they are often able
to address the patients’ questions directly
without having to route the call elsewhere.
Billing Analyst: Since the CWH is considered an outpatient facility, two bills are issued
from each outpatient visit. One is the Physician’s
charge, and the other is called a Facility Fee, for
the usage of the facility and those associated services. It is the responsibility of the Billing Analyst
to submit all charges from the Facility Fee to the
patient’s insurance company. For each patient
visit, the Front Desk prints out what is known as
a Fee Ticket (Fig.2.2), which is a list of procedures which may be done in the ofce. This is
completed by the nurse, following the patient’s
visit. Once the Fee Ticket is completed and turned
in, the Billing Analyst will call the patient’s
insurance company to gure out if Prior
Authorization is needed for an outpatient procedure. Once the authorization is either obtained or
not needed, the charges are entered into the hospital’s billing system. From charge entry a tally is
generated, which compares the number of
charges with relation to the number of patients
seen for the day. A reconciliation spreadsheet is
then lled out and submitted to the Outpatient VP
of the hospital weekly. This document accounts
for missing charges or an abundance of charges
vs. the number of patients seen in the clinic. The
Billing Analyst is also responsible for the copay-
ment report, which lists the targeted amount vs.
the actual amount collected for the day. On the
second column of the copayment report, it lists
the balances patients have accrued within
MedStar and compares it to the total amount collected at that patient’s appointment. An outstanding balance sheet is then given to the patient at a
subsequent check-in, so the patient is informed of
the amount owed. At the end of each business
day, once the batches have been closed, the
Billing Analyst takes any cash deposits to the
Cashier’s Ofce. Other duties include documents
scanning, authorization for substitute skin graft
materials, code edits, and approvals for single
case agreements (Fig.2.2).
Executive Assistant (EA): The EA acts as
our most embedded Provider resource. Their role
involves assisting with the needs and requests of
all our Attendings and NPs. These tasks are allencompassing, but include travel coordination,
submission and tracking of reimbursements,
maintenance and distribution of Provider calendars and the monthly on-call schedules, and
meeting coordination. The EA is also responsible
for the upkeep of an Excel sheet which details
Provider licensing renewals and credentialing
updates. The position serves as a backup desk for
PSC (A)’s role in scheduling surgeries and submitting the related Provider billing, and other
associated CWH-related tasks are substantial.
They include, but are not limited to, department
key copy and ofce supplies requests, coordinating staff lunches and potlucks, arranging and
execution of staff retreats, and departmental mail
distribution. Additionally, our EA coordinates
and oversees our monthly Amputee Support
Group, which has become an invaluable resource
and forum in ongoing support of our patient
population.
Hyperbaric Technicians and Safety
Director: The Hyperbaric Technician operates
the hyperbaric chambers and ensures the safety
and close monitoring of the patients throughout
their HBOT sessions. They provide instructions
and documentation on the details of service and
collect data points (e.g., vital signs, blood glucose monitoring, etc.). The Tech is responsible
for reporting any abnormal reading or immediate
2 Stang andDay-to-Day Management: TheNuts andBolts ofRunning aWound Care Center
Данная книга находится в списке для перевода на русский язык сайта https://meduniver.com/
21
Fig. 2.2 Fee ticket
22
A. Ellis and T. Wallace
change in the patient’s condition to the Attending
and Nurse Coordinator. Each accredited
Hyperbaric facility also has an on-site Safety
Director. The Safety Director is responsible for
ensuring the hyperbaric chambers and associated
equipment are fully operational, and that the
safety guidelines are met daily. Before a patient is
permitted inside a chamber, they inspect for and
remove any restricted or potentially hazardous
materials. The Safety Director also works in collaboration with the Program Director to coordinate all hyperbaric chamber upgrades,
modications, and repairs.
Page 8: TheTriage Desk
The CWH Triage desk is an integral operational
component of our practice model. This element
allows for us to gather and share information,
streamline ongoing coordination of patient care,
and ensure that our patients’ needs are met efciently and in full. The Triage desk is staffed primarily by our Patient Services Coordinator and
the designated Triage RN for that day. There are
also backup coverage plans for any associate
absences, which involve Triage task designation
to various members of our team for that duration.
• Triage Line: The CWH Triage line is given to
every patient in their Visit Summary at every
visit and included in every practice-related
communication we send out—to patients, clinical colleagues, referring Providers, etc. Patients
(or anyone) are encouraged to call this line if
we can assist them in answering any questions,
or with anything regarding their clinical needs,
with relation to our practice specialty. From
0800 to 1700 this line is answered by either the
Patient Services Coordinator or the Triage RN,
and the voicemails are checked hourly. Offhours there is a voicemail directive which reiterates our availability, but which also provides
instructions for how to reach the on-call
Resident by pager if needed.
• GUH-CWH Pools: Triage works out of two
electronic Inboxes in our charting system
which are designated to and shared by our
practice exclusively.
– Clinical Pool: Patient-related requests for
action are sent to these Pools at all hours by
our own team, by other practices, or by our
patients, via our entity’s electronic Patient
Portal system. The Triage Nurse attends to
the task requests and messages in the
Clinical inbox throughout the day, updating the notes with details as they go along,
and deleting them when the task is
complete.
– Admin Pool: Any patient Scheduling
requests are sent to the Admin Pool, which
is checked on and addressed by our Patient
Registration Associates (PRAs) at the
Front Desk daily. They will also update
these notes as they go along, until the task
is completed and the note can be deleted
from the Pool.
• Patient Portal: Patients are provided with
information at each visit as to how to sign up
for MedStar’s Patient Portal service. This
allows them to create an online prole within
MedStar from which they can access their
medical records, diagnostic imaging and
testing reports, appointment information,
and laboratory results. They can also use the
Portal to send their Provider an “email”
communication, which goes directly to that
Provider’s practice-afliated Clinical Pool
to address. Patients can attach pictures or
documents to these messages, and we can
Reply to them directly from the Pool. The
expectation or Triage is that patients will
hear back within 24 h of contacting us,
whether via phone call or sending a message
to the Pool.
Page 9: What Makes forTriage Desk
Success
Staff, Provider, and Patient involvement are the
keys to operational success in this aspect of
ensuring continued, comprehensive support of
our high-risk patient population.
2 Stang andDay-to-Day Management: TheNuts andBolts ofRunning aWound Care Center
Данная книга находится в списке для перевода на русский язык сайта https://meduniver.com/
23
• Staff: Much of why our Triage desk is successful is because of our staff’s dedicated contributions on the day-to-day. Our on-site team
is relatively small (<20 associates), and we
stay in constant communication both inperson and electronically throughout the clinic
day, via the systems we have established. All
our associates are intimately involved in some
aspect of the patient’s journey through our
practice, and thus every member of our team
contributes to this desk—by offering insight
and updates from the patient’s visits or history, by answering the incoming Triage calls
to their desks, and by following up on designated Triage-related tasks.
• Providers: Our Providers are accessible to
our team as resources 24/7. They are diligent
about checking their electronic inboxes and
returning their messages, they check in personally with the desk to see about any outstanding tasks for which they are needed, and
they are at minimum reachable by phone. If
you cannot get in touch with one of them, you
can absolutely get hold of another. This availability allows us to ensure we are meeting
especially the most critically important patient
needs in a timely manner and helps to instill a
mutually trusting and productive relationship
between the Providers and staff, and the
Providers and our patients.
• Patients: We have been able to cultivate
patient buy-in to this desk and to the Portal
through a long and consistent history of efciently and successfully addressing their needs
by these routes. We often hear patients say that
they call our ofce rst, no matter what their
needs, because we are “the ones who pick up”
when they call, and because they know at the
minimum we can assist them to get in touch
with whomever they are trying to reach. Our
patients are a high-risk population with multiple and ongoing complex care needs, and it
gives them great comfort to know that we are
reachable and reliable on the day-to-day.
It is truly not possible to accurately convey
the complexity and breadth of our Triage operations. There are so many moving parts, so
many variables, and so many people involved,
that it would be an incredibly daunting task to
try and break it down in a way which could be
straightforwardly understood. It is one of the
most valuable services that we are able to offer
with regard to continuity of patient care, and
one of the shining achievements of our practice
model.
Page 10: Scheduling
Scheduling coordination is a complex but vital
component of our operations. We have several
schedules in ux at any given moment, which
require constant updating, monitoring, and disseminating. They provide the structural guidelines of our operations and are essential for
tracking Provider and staff availability, and in
guiding our patient bookings. All of our published calendars and schedules are kept up-todate by the Nurse Manager and are accessible to
our team 24/7 on our practice Share Drive. Any
Provider booking template modications are
done electronically by the Patient Services
Manager.
Clinic Master Calendar (Fig.2.3)
This calendar provides an upcoming look at our
Provider Clinic Coverage schedules, so that we
can see which Provider is available on what date,
and where there is alternate coverage if a Provider
is out. The Nurse Manager updates and disseminates this schedule to our team at least weekly,
and anytime there are changes to Provider coverage. It is posted in every Exam Room and at
every workstation to allow for at-a-glance guidance as to how we can book patients in
follow-up.
24
A. Ellis and T. Wallace
Fig. 2.3 Clinic master calendar
2 Stang andDay-to-Day Management: TheNuts andBolts ofRunning aWound Care Center
Данная книга находится в списке для перевода на русский язык сайта https://meduniver.com/
Fig. 2.4 Outlook master calendar
25
Page 11: Scheduling
Outlook Master Calendar (Fig.2.4)
This is our shared practice Master Calendar, which
our team is all able to access in Microsoft Outlook.
It provides a more global overview of Provider
coverage plans and clinic breakdowns and includes
additional notes for reference. These notes detail
staff who are scheduled out, upcoming team or
patient-related meetings, shared clinics with other
practices, or any anticipated on-site Observers. The
Outlook Calendar includes both recurring and onetime events and allows for a look at our clinical
operations both historical and upcoming. Managers
and varied members of our Administrative staff
have editing capability for this calendar, and it is
used by the Nurse Manager to guide practice coverage needs in creating the Clinical Staff Schedules.
Page 12: Scheduling
Provider andOrthotic/Prosthetic
Coverage Template (Fig.2.5)
This is another quick-glance reference which
lays out our standard, baseline Provider coverage template for the Clinic and OR on the dayto-day. It also includes updated anticipated
on-site Orthotic/Prosthetic (Hanger Clinic)
associate coverage. This template is available
in our Share Drive and posted at the primary
workstations around clinic. It is helpful to our
associates as a reminder of our Master
Template for CWH operations and to see who
will be on-call that day for our Orthotic/
Prosthetic partners.
26
Updated Provider Templates as of 1/4/21
7C
1.8.21, AE
A. Ellis and T. Wallace
Monday TuesdayWednesday Thursday Friday
AM CEA Clinic KKE Clinic CEA Clinic CEA Clinic JSS Clinic
Atves Clinic Atves Clinic Akbari Clinic JSS Clinic Kerry NP Clinic
Benedict AM Benedict Benedict
PM Nicole NP Clinic KKE Clinic Nicole NP
Atves Clinic Atves Clinic Benedict PM JSS Clinic Kerry NP Clinic
Benedict Benedict
OR JSS/KKE OR21 CEAAM/PM
Monday TuesdayWednesday Thursday Friday
Elisa 8:30-2:308:30-2:30 8:30-2:308:30-2:30 8:00-5:00
Richard Fairfax 8-5MGUH 8-5MGUH 8-5Fairfax MGUH 8-5
CWH John xxBen/Charlie (alt)x
Jan 4JohnJan
Jan 11 John Jan 14 Ben
Jan 18 John Jan 21 Charlie
Jan 25 John Jan 28 Ben
OR22 CEA AM
Hanger Coverage as of 11/3/20
Hanger Schedule for CWH, 2021
Clinic
KKE Atves/KKE OR21 CEA AM/PM
Kerry NP Clinic JSS Remote/Tele
(1/4/21, AE)
CEA Remote
1:40pm-4:00pm
OR22 CEA AM/Atves
PM
(KKE)
harlie
Fig. 2.5 Provider and orthotic/prosthetic coverage template
Page 13: Scheduling
Upcoming Clinic Numbers (Fig.2.6)
This is an Internal Document which is published
to our Outpatient Team on a once- or twiceweekly basis. One of our nurses will be tasked to
do an overview of the upcoming patient numbers
on each Providers’ schedule, looking ahead
about a month forward. The Nurse Manager then
does an overview of the numbers and uses a
color- coding system to indicate which schedules
are full and should be “frozen” from further
booking, which schedules are okay to add on for
emergencies only, and which schedules are open
and available for booking. This schedule also
serves as another reference point for upcoming
Provider coverage (who is here, who is out, and
who is covering alternately). The Nurse Manager
sends this out to staff via email and publishes
and disseminates color copies for that day to all
2 Stang andDay-to-Day Management: TheNuts andBolts ofRunning aWound Care Center
Данная книга находится в списке для перевода на русский язык сайта https://meduniver.com/
27
Fig. 2.6 Upcoming clinic numbers
schedulers’ desks for their reference. Upon
receiving that day’s schedule, our EA will then
“freeze” any provider schedules (red or yellow
dates) in the virtual Provider template from further booking by Central Scheduling. Only our
staff can add appointments from there. The pur-
pose of this schedule is to assist in getting our
patients scheduled evenly across Provider availability, to limit overbooked schedules, and to
ensure our team has a quick-reference guideline
as to where there is immediate availability for
booking.
28
PLAN FOR THURSDAY, 1/28/21
NOTES:
TIPS at 0800: Paent Case Presentaon HK
Dr. Steinberg has room for add-ons today prn.
Amputee Support Group is tonight at 5 via Zoom
Have a great day everyone!
SCHEDULE/STAFFING
Dr. Anger has AM (26)
Kerry NP has PM (9
NP:
RNs:
MAs:
Dr. Steinberg has AM (23) and PM (10)
NP
RNs:
MAs:
Dr. Benedict has AM Clinic (2) and PM Clinic (2)
Dr. Johnson-Arbor has AM (2
LUNC
12:30
1:00
1:30 –Lloyd
x4-6161:
Triage:
Hanger coverage/x4-1987:
Code Cart:
Ou
Shinea
Margaret
Thalia
A. Ellis and T. Wallace
Page 14: Scheduling
Kerry
Sara (7-5:30), Jacqueline (7-5:30)
Donnell (7:30-4), Iris (8-4:30), Lloyd (8:30-5 float)
: Nicole
Lauran (7-5:30), Amanda (7-5:30)
Anna (7-4:30), Amber (8-4:30), Lloyd (8:30-5 float)
H:
–Sara, Lauran, Donnell, Anna
–Jaqueline, Amanda, Iris, Amber
Tynisha (8-4:30)
Amara (6:30-5)
t:
Fig. 2.7 Plans of the day
)
)
Ben H.
Lauran
.
Plans oftheDay (Fig.2.7)
These Plans are sent out daily via Outlook email
by the Nurse Manager, or by the designated covering Triage nurse for that day. They are sent to
all our inpatient/outpatient team members, as
well as to our clinical partners—Radiology,
Scribes, Physical Medicine and Rehab, Hanger
Clinic, our Chief Resident, and Case Management.
The Plan breaks down the clinic setup and assignments for the day, any alternate Provider coverage, any staff outages, and includes any pertinent
notes for that day’s operations.
Page 15: Scheduling
Clinical Sta Schedules (Fig.2.8)
These are the weekly clinical staff scheduling
assignments, which also include notes about any
anticipated alternate Provider coverage, staff
outages, and any important upcoming events.
They are made and distributed by the Nurse
Manager, optimally about a month in advance
(i.e., send out the schedules for all of February
in early January). These templates are used, in
conjunction with the Outlook Master Calendar,
to make that day’s Plan of the Day. Note here
the staggered staff start times for the CMAs, and
the longer hours and variable “Out” days for the
RNs (as they work four 10-hour shifts).
2 Stang andDay-to-Day Management: TheNuts andBolts ofRunning aWound Care Center
Данная книга находится в списке для перевода на русский язык сайта https://meduniver.com/
Monday Tuesday Wednesday Thursday Friday
4CLINIC
Dr. Anger (AM)
with Nicole NP (PM)
RNs:
Briana (7-5:30)
Amanda (7-5:30)
MAs:
Iris (8-4:30),
Amber(8-4:30),
J
Lloyd (8:30-5 float)
Dr. Atves
A
RNs:
Sara (7-5:30)
Jacqueline (7-5:30)
N
MAs:
Anna (7:30-4),
Donnell (8:30-5)
Lloyd (8:30-5 float)
Dr. Benedict (AM)
x46161:
Tynisha (8-4:30)
2
Triage:
0
Amara (6:30-5)
Out:
2
Ebrima
Margaret
Velma
1
Lauran
Notes:
5CLINIC
Dr. Evans with
Nicole NP
RNs:
Lauran (7-5:30)
Amanda (7-5:30)
MAs:
Anna (7:30-4),
Amber (8-4:30),
Lloyd (8:30-5 float)
Dr. Atves
RNS:
Sara (7-5:30)
Jacqueline (7-5:30)
MAs:
Iris (8-4:30),
Donnell (8:30-5)
Lloyd (8:30-5float)
x46161:
Tynisha (8-4:30)
Triage:
Briana (7-5:30)
Admin:
Amara (6:30-5)
Out:
Ebrima
Velma
Notes:
Mary Hicks RN
(WOCN Student)
Shadowing
6CLINIC
Dr. Atnger (AM)
Nicole NP (PM)
RNs:
Briana (7-5:30)
Lauran (7-5:30)
MAs:
Anna (7:30-4),
Amber (8-4:30),
Donnell (8:30-5),
Lloyd (8:30-5)
Dr. Benedict (PM)
Desk/Supply
Orders:
Iris (8-4:30)
x46161:
Tynisha (8-4:30)
Triage:
Sara (7-5:30)
Out:
Ebrima
Amanda
Amara
Jacqueline
Thalia
Notes:
7CLINIC
Dr. Anger (AM)
with Kerry NP (PM)
RNs:
Jacqueline (7-5:30)
Lauran (7-5:30)
MAs:
Amber (8-4:30),
Donnell (8:30-5),
Lloyd (8:30-5 float)
Dr. Steinberg with
Nicole NP
RNs:
Amanda (7-5:30)
Briana (7-5:30)
MAs:
Anna (7:30-4),
Iris (8-4:30),
Lloyd (8:30-5 float)
Anger RemotePM
x46161:
Tynisha (8-4:30)
Triage:
Sara (7-5:30)
Admin:
Amara (6:30-5)
Out:
Ebrima
Margaret
Notes:
Happy Birthday Iris!
Mary Hicks RN
(WOCN Student)
Shadowing
Podiatric Residency
Interviews in PM
8CLINIC
Dr. Steinberg (AM)
NO REMOTE PM
RNs:
Lauran (7-5:30)
Amanda (7-5:30)
MAs:
Amber (8-4:30),
Donnell (8:30-5),
Lloyd (8:30-5float)
Kerry NP
RNs:
Jacqueline (7-5:30)
MAs:
Anna (7:30-4),
Iris (8-12),
Lloyd (8:30-5 float)
Desk: Iris (1-4)
x46161:
Tynisha (8-4:30)
Triage:
Amara (6:30-5)
Out:
Ebrima
Margaret
Briana
Dr. Benedict
Nicole NP
Sara
Velma
Notes:
No PM Remote
visits forSteinberg
29
Fig. 2.8 Clinical staff schedules
Соседние файлы в папке Библиотека им академика М.И. Перельмана