The 10 Steps of Pre-visit Planning
The strategies involved in pre-visit planning are meant to streamline appointments, improve communication between patients and providers, increase physician and clinic profitability and enhance the quality of medical care provided at a given clinic.
This process creates a proactive clinic environment instead of a reactive environment which increases the time available. When planning ahead, we can be more deliberate and ensure we hit quality metrics and system goals while correctly billing payers. Overall, pre-visit planning increases the efficiency and profitability of medical care while simultaneously improving patient care.
THE AMERICAN MEDICAL ASSOCIATION RECOMMENDS THE FOLLOWING STEPS FOR IMPLEMENTING PRE-VISIT PLANNING:
Re-appoint the patient after the visit.
Use a visit planner checklist to arrange the next appointment(s).
Arrange for laboratory tests to be completed before the next visit.
Perform visit preparations.
Use a visit prep checklist to identify gaps in care.
Send patients appointment reminders.
Consider a pre-visit phone call or email.
Hold a pre-clinical team huddle.
Use a pre-appointment questionnaire.
Handoff the patient to the physician.
STEP 1: RE-APPOINT THE PATIENT AFTER THE VISIT.
Follow-up appointments should be scheduled before the patient leaves the clinic, thus eliminating extra time spent contacting people and scheduling via phone. This includes appointments for laboratory tests.
STEP 2: USE A VISIT PLANNER CHECKLIST TO ARRANGE THE NEXT APPOINTMENT(S).
A visit planner checklist provides goals and a clear plan for the patient between appointments. The checklist also ensures that no steps are forgotten when coordinating follow-up care for the patient. A checklist can also be used by medical professionals of all levels or other clinic personnel, thus not requiring a physician for implementation.
STEP 3: ARRANGE FOR LABORATORY TESTS TO BE COMPLETED BEFORE THE NEXT VISIT.
Pre-appointment completion of laboratory tests enables the actual appointment to be used for discussing the results and making action plans for addressing test results. Therefore, with pre-visit planning, the appointment is aimed at treatment instead of testing.
STEP 4: PERFORM VISIT PREPARATIONS.
Preparations for an appointment are essential for creating focused and intentional clinic time. Preparations include reviewing medical history and notes from previous appointments, identifying gaps in medical history that can be addressed during the appointment (for example, new vaccines or newly available medications), and providing test results for the patient. These preparations can be completed by any healthcare worker in the clinic or by our pre-visit planning app, which enables flexibility in completing these items.
STEP 5: USE A VISIT PREP CHECKLIST TO IDENTIFY GAPS IN CARE.
A visit prep checklist can be used to keep the patient up-to-date on medical care, including vaccinations and cancer screenings. Electronic health records are extremely helpful in keeping patients up-to-date on medical care. If electronic health records are not available, paper records should be reviewed prior to the patient’s appointment. The visit prep checklist enables gaps in care to be addressed at the current appointment instead of requiring an additional appointment to be scheduled.
STEP 6: SEND PATIENTS APPOINTMENT REMINDERS.
We are all human, and humans can be forgetful. Appointment reminders can decrease the number of no-shows to appointments, which are a waste of time for providers and prevent other patients from scheduling appointments for those time slots.
STEP 7: CONSIDER A PRE-VISIT PHONE CALL OR EMAIL.
Contacting a patient prior to their appointment can be especially helpful for more complex patients. During pre-visit communication, medications can be updated, and the patient’s goals for the appointment can be evaluated. This information can save time during appointments and can help focus appointments.
STEP 8: HOLD A PRE-CLINICAL TEAM HUDDLE.
A team meeting starts the day with organization and decreases the surprises that may occur during the clinic day. Important topics to review during the team meeting can include staffing changes, scheduling updates, and issues that may require special support (such as an interpreter). By making an organized plan first thing in the day, the clinic time will run more smoothly and efficiently.
STEP 9: USE A PRE-APPOINTMENT QUESTIONNAIRE.
Providers can give patients a questionnaire prior to their appointment to save time during the visit itself. The questionnaire can address patient goals for a visit, update medication lists, assess patient pain and depression, and address other standard medical questions. Handling these questions prior to the appointment enables the care provider to focus on the patient’s needs during the visit.
STEP 10: HANDOFF THE PATIENT TO THE PHYSICIAN.
The medical assistant (MA) or nurse will be the first person to question the patient during the appointment. The information the MA or nurse learns should be communicated to the physician or primary care provider during the handoff of the patient. The MA or nurse can therefore direct the appointment to address items of interest for the specific patient that day.
