Symptoms
60yr old M: Pt is requesting to be seen in office. Had had a cold/sore throat, ear pain and cough for ~ 6 weeks, it will not go away.
What is:
MA/PSR- Schedule an appointment with their PCP due to chronic condition. If no availability within 3 days-schedule with supporting provider or have them come to walk-in
Reason: Typical chronic respiratory illness symptoms
If a patient comes in for an MA visit for vaccine (B-12) does the provider still need to sign off on the encounter and close it?
What is:
MA : Yes, the provider still has to sign off on the B-12 unless ordered prior to visit. Med needs to be scanned and chart closed as a NLOS
Why: MA's are not allowed to order and sign off on B-12-out of scope
50 M: Messages thru Mychart- I've been having penile pain and swelling for a month. I don't want to see the doctor, that's uncomfortable. Just give me a referral to Urology - (note, he has not been in the office in 2 years.)
What is:
MA: Forward to RN's inbasket due to trigger word of pain-RN will call and triage pt
Why: Trigger word Protocol
Older male-Checking in at the front desk for walk-in and states he is having chest pain. Before the PSR can get the name and dob, pt grabs his chest and falls to the ground. Nobody is with him.
What is:
PSR: 1 PSR-Call 911, 2nd come to the back and grab RN/MA/Doc- MA-grab Emergency bag and vitals cart
Reason- Chest Pain Protocol
11 y/o F- MOC messaging - my daughters school is requiring this general appraisal form to be filled out ASAP. Please have provider fill out and let me know when its ready to be picked up.
** patients last WCC was over a year and a half ago**
What is:
MA- call MOC and advise her that patient needs to be seen for her annual exam (WCC) so we can fill out the form with current/accurate information. Schedule patient for a WCC.
Bonus: What if we've seen patient within the last year?
36 yr old M: Calls and advises he is having an allergic reaction with shortness of breath. He wants to see his Provider
What is:
PSR: Call should be transferred to Triage RN (Christy) (if no Christy) then start a TE and do a warm transfer to CareEverywhere Nurse
WHY: Allergic Reaction and SOB are trigger words
39 F: Pt calling for a refill of Losartan. Her last ov was 1 yr and 2 months ago to the day. She is refusing to come in for an appointment because her blood pressure is controlled at home. How do you proceed?
Extra Credit..bp cuff was validated at last ov
What is:
PSR/MA: Be understanding but also advise of protocol. Schedule her for an appointment and give a 30 day temp refill.
Why: Give her the why- We need to see our patients annually for labs and in office blood pressure to make sure blood pressure remains at target range.
Extra Credit: 10 pts-bp not validated after 1 yr
40 F: I got an order for an ultrasound. I have been waiting to schedule for a month. Touchstone is saying they don't have the order. What is going on? You say you did, they say they didn't get it! What is going on with your office?
What is:
MA: Review the order in Epic, make sure it is ordered correctly. Print it out, refax it to confirmed fax # and then call to make sure they got it.
55 F: Pt comes to the front desk and looks pale, is sweating, and having a hard time speaking. they state they are here for labs. The patient takes the iPad and starts walking to sit down, but they faint and start convulsing on the ground.
What is:
PSR: 1-PSR call 911, 2nd PSR- get RN/MA/Doc from back
Why: Follow Emergency protocol
Bonus: Is it a stroke? Seizure? Blood Sugar? How to know
88 F: Daughter (MPOA) is requesting FMLA paper work to be filled out by patients PCP so that the daughter can stay home and help.
What is:
MA- Call daughter and schedule appointment for patient to see PCP to discuss. Advise daughter that she needs to be present at appointment to fill out forms accurately.
36 F: I have been having burning with urination for a few days and going more frequently. I have had UTIs in the past and know what they feel like. Can I get a prescription sent?
What is:
PSR/MA: Schedule appointment, Co-visit, Connect Care (NAVV)/Walk-in
Why: We cannot prescribe meds without an ov and doing the testing
68 F: Pt wanting call back regarding her side effects since starting her medication for vertigo. Pt has been having hot flashes, nausea, light headedness and sees spots. Pt feels her head is swollen, and her head itches. Should she stop the medication immediately, or stop gradually little by little?
What is:
MA/PSR-Route to RN-if not available then document TE and route to Connect Care RN
Reason: New Symptom, side effect or reaction to medication question
45 M: I have completed 4 weeks of PT for my knee but I am still having pain. Please order an MRI for further assess - I would rather not have to come in for an appointment if I can avoid it.
What is:
MA advise patient to schedule an appointment for reassessment as appropriate document is necessary for insurance to consider covering imaging.
MA has just completed giving a vaccine. You notice that the expiration date was actually yesterday. What do you do?
MA: Let the patient know immediately. Let your provider know, management as well. A safety net must be filed and report to CIIS. Make sure to reassure your patient as well. Follow PCP direction on repeat vaccine
47 M - I have been struggling getting myself back to my "norm". I would like to extend my STD to 4 more weeks out. This will allow me to get in with therapy and tweak any medications as appropriate. Please fill out form ASAP and submit to my employer as I can't go without pay.
What is:
MA- schedule patient for either a virtual/in-person visit. Explain to the patient that our provider needs to assess and have supportive documentation that justifies the request.
2 mo M: Mom calling, Child has been having a fever of 103.1 and pulling on right ear. He is inconsolable. What can I give him?
What is:
PSR/MA: Route to RN for triage/ if not in office transfer to Connect Care RN and document a TE.
Why: Fever >102 is a trigger word alert
78yr old F: Calls crying and angry-I need a refill of my Oxycodone! My back is spasming so bad and feels like it is breaking in half- I can't make it in as I do not have transportation and I can't get out of bed. Will someone just refill the damn thing!!!!
What is:
PSR-Route to MA or RN so they can explain to the patient protocol on refilling Opioids
Reason: Pt needs an appointment for Opioids- takes PSR out of the mix. MA/RN to follow protocol
65 M: My GI doctor wants labs done and told me to go to my PCP. Please see attached lab orders. Let me know when orders are in so I can make an appointment.
What is:
MA respond to patient letting them know that we are unable to draw needed labs in clinic as our providers would need to order under their name. Advise patient to go to Quest or Lab Core for needed labs.
Bonus: if patient gives push back or if we've done a simple PSA for pt before, queue lab and route to provider
A patient comes in at 1205pm and tells the front desk that there is a woman passed out on the outside sidewalk up front. She is unresponsive but he can tell she is breathing.
What is:
PSR- 1 calls 911, the other grabs MA/Doc because Christy is at lunch. When they go out to help the patient-they discover, it is Christy. How do we proceed
77 y/o M- Patient dropped off Handicap parking privileges' application for PCP to fill out and sign. Patient is now back 1 day later requesting to pick up the form.
What is:
PSR/MA- review patients chart for any documentation of the status of form. Go to designated MA for that PCP. Review folder. If not in folder, speak with MA to check on status. (please see work flow inside each folder)
** We are allowed up to 72 hours to fill out paperwork**
67 F: MyChart message -
I have been having chest tightness in the middle of my chest since yesterday. I also fell off of my ladder and hit my head this morning and it's bleeding. I'm worried because I take blood thinners? What do I do?
What is:
PSR/MA Route to RN. If not available document TE and route to Connect Care RN and warm transfer
Why: Trigger words-Chest Tightness/ head trauma/ bleeding
53 yr old F: Is in the clinic for Menveo vaccine and needs to leave right after to pick up her kids. She is insisting to leave right after administration of the vaccine.
Extra Credit: Patient continues to leave.
What is:
MA: Apologize to patient for inconvenience, explain policy on 15 min observation time required for safety precautions.
Extra Credit: If patient still insists on leaving, chart patient refusal, notify management and provider.
Why:
72 M - I am calling to see where my CPAP is? I had the study done 2 months ago, and had my office follow up 1 month ago. I keep getting the run around and find out they are waiting on the sleep study report-
What is:
MA: Review order through Parachute. If it has been ordered, get the fax# to the facility and physically fax it over-do not send thru Epic. Apologize to the patient and explain you are taking care of it. If it hasn't been handled-review everything thus far and work on getting it done
32 yr old F- Sends inbasket message stating we violated her rights. She also threatens with a lawsuit
What is:
Send message to both Jody and Chris to look into it and they will reach out to the patient and our legal team
35 M- Approaches front desk-I need my meds refilled, I sent a Mychart message yesterday and nobody has gotten back to me. I need my pain meds now!!
What is:
PSR- After getting the pt's name and dob, review patients chart to see if the med was sent in. If you do not see that it was, has there been a reply sent to the pt (confirm 1st by chart) Call the MA and let them know the situation. MA will review, however Med refills are 48-72 hours per Protocol as well. MA to approach pt with the answer.
Bonus: What if patient requests to get blood thinner or heart med refilled?