Efficiency in the Urgent Care

Mike Weinstock MD, Kirk Hummer NP and Jenny Messick MD

THE STAFF

● Physicians, nurse practitioners (NPs) and physician assistants (PAs) all work together and all play to each other’s strengths. For example, the Emergency Medicine trained provider may have more procedural experience, while the NP may be more up-to-date on current primary care practices.

● There is no need for a well-defined hierarchy. Put the patient first and it all falls into place. Use everyone to their fullest abilities.

● Non-provider professional staff. Registered Nurses (RNs) and Registered Radiographic Technologists (RRTs) can be cross-trained to do basic patient care. They both can room a patient, get vital signs, assist with procedures and discharge patients. They remain differentiated only by those activities that are legally defined: the RNs give medications and the RRTs use ionizing radiation. This allows patients to move quickly through without waiting for different providers to perform a narrow, specified skill.

● Communicate these expectations to people upon hiring. Over the last 7-8 years, Urgent Care Medicine is becoming a specialty and the jobs are highly desired. This allows for great selectivity in the hiring process.

● The front desk person is critical. Every patient passes through this individual, who controls the lobby and needs to have some small sense of medical judgment. It is well worth the effort to put time into training this person, paying appropriately and offering benefits that allow good people to stay in the position. It is worth it because this person is the face of the company.

● If there are multiple Urgent Care Centers (UCCs) within an organization, different staff can rotate to different locations. However, there is a value in “anchoring” staff to specific centers because it fosters teamwork and ownership.

THE FACILITIES

● The best centers are designed so that the provider has a direct line-of-sight to all the staff and all the exam rooms. A lot of information is gained by watching a patient walk into the exam room.

● Develop Universal Rooms. Design and stock every room with the capacity to perform a pelvic exam, incision and drainage, and wound, throat and flu culture swabs. Set up every room, at every center, the same way. Not only is there a flu swab in every room, but it is in the same drawer in every room. This makes it easier to stock, and gives providers a sense of comfort as they rotate between the different centers.

● It is extremely important that you stick to your posted hours because the public expects you to be open when you say you are, and they will show up seeking help.

Remember, most of the profit at a UCC is made on the last few patients of every day. Most of the patients seen throughout the day support the existence of the center, the cost of the staff, the supplies, etc.

PROTOCOLS

● It is possible to get every patient in and out within 30 minutes. This can be and is achieved on a regular basis, but is only possible when there is a true team effort.

● A good, experienced team means that every member does not have to wait for the provider’s order. If a patient comes in with a crush injury to the hand, the RRT can perform an x-ray and the RN can prepare the tetanus shot and start cleaning the wound at the same time that the provider is taking the history.

● Urinalysis. Train the staff to obtain and test urine immediately in any woman of childbearing age, and in any patient presenting with an abdominal, pelvic or genital complaint. This can save 15 minutes every visit, when it is done proactively every time.

● X-rays. Orient the RNs and RRTs on the appropriate films to get, from the fingers to the elbows and the toes to the knees. Films involving radiation to the trunk should still be ordered by, or at least discussed with, the provider in advance.

Give a hard copy of the image on a disc to every patient to ensure appropriate follow-up with a primary doctor or orthopedist if necessary.



This is an excellent PR move - if a patient walks out with something in his/her hand, that patient feels like something was done for him/her.

● Pelvic Exams. Train your professional support staff to anticipate when patients may need a pelvic exam, and to set everything up, including the gown and top-sheet, equipment and culture mediums before the provider enters the room.

● Know the patient population that comes to your UCC and the antibiotic resistance within the community. What percentage of your cultures come back positive for MRSA? Anticipate test results and act accordingly.