Better management of same-day appointments, frees up GP time and improves patient access
From L-R: Sue Thomas, Sian Colnut, Mich Brooks, Mary West, Karen Carpenter, Fiona McDonald, Dr Philip Frost, Jeanette Banks, Dr Maree Burke, Jane McLeod, Brana King
As part of becoming a Health Care Home, the team at East Care Health have changed the way they manage same-day requests to see a doctor and made some startling improvements for patients and staff.
East Care GP Marie Burke says simply booking GP appointments for patients who requested to be seen that day meant that some people who could wait longer were being seen immediately, while others who had more pressing health issues were waiting because there wasn’t a slot available. “We also found some patients requesting same day appointments didn’t need to see a doctor but could be treated by one of our four nurses,” she says.
East Care’s solution has been to introduce a nurse-led triage system and nurse appointments for people assessed as needing to be seen that day. At least three nurse triage appointments are set aside in each GP’s Medtech calendar every day.
Marie says that nurse-led triage means that decisions about who needs to be seen urgently are made by the clinical team. Some patients are booked to see a doctor or nurse that day and others are booked for an appointment later in the week. Most people booked to see a nurse, also see one of East Care’s four GPs but time spent with the GP is usually shorter because of the initial nurse assessment.
“Often a nurse will say, 'I’ve got someone in the treatment room, can you please take a quick look'. Sometimes it’s as simple as giving advice on a dressing or deciding whether a wound should be sutured,” Marie says. “The system works really well for parents who might just be a little worried about a sick child and want some advice and reassurance.”
Rather than needing to interrupt a GP consultation to say there is someone in the treatment room, nurses can send a message via Pegasus’ instant messaging system, Jitsi. East Care’s GPs are also using it to ask questions of local pharmacists and reception staff can keep in touch with nurses about patients in the waiting room.
One of the popular aspects of the new same-day appointment system is that appointments are cheaper when people don’t need to see a doctor. “Patients also like the fact that the notes taken during the initial nurse triage are available during their consultation, so they don’t have to tell their story from the beginning," Marie says. “I haven’t heard anyone say they didn’t want to see a nurse or that they had to jump through hoops to get an appointment.”
While Marie says days can be more pressured for East Care’s nurses, they are now working closer to the top of their scope of practice and passing on work that doesn’t require clinical input to the administration team. The system is also freeing up GP time and Marie says they are “running a lot less behind these days”.
The extra time available to GPs means that they can afford to spend more time with high needs patients. East Care has twice as many patients with high health needs as most other Christchurch General Practices. “Some patients are always going to take longer than 15 minutes to see and this system allows more time for them to receive the care they need,” Marie says.
The changes at East Care have been a team effort and often guided by the “big picture view” of Care Coordinator Sian Colenutt. “We all get on well together and there aren’t any barriers to people raising something or suggesting a new way of doing things. We have a weekly clinical meeting to discuss these ideas, amongst other things," Marie says.
To ensure the system doesn’t break down when one of the nurses is away, East Care employs the same locum nurse who Marie says "understands the new way of working and enjoys working at the top of her scope of practice".