Enhancing continuity for patients and clinicians: The care team model

Background: Continuity between a patient and his/her medical providers is paramount in providing care that reduces preventable illness cost-efficiently. It has been shown that lower continuity in an outpatient setting is associated with a higher rate of emergency room admissions. In addition to exploring the Care Team Model as a means for improving patient-physician continuity, permanent staffing assignments will be used to reduce waste and improve clinic flow. It is common for hospital personnel to be misallocated due to a lack of standard procedures and the inability to predict patient volume in a clinic that has not achieved sustainable continuity. The result is wasted resources or overburdened staff. Methods: The Care Team Model sought to improve continuity between patients and physicians and to implement a standardized staffing schedule. Patient-provider assignments were based on previously established continuity and patient preference. Staff scheduling was rearranged to encourage continuity among nursing, clerical, and medical staff. All clinic personnel were given a designated location to ensure that they work with the same team on a regular basis. Results: Preliminary results suggest that visit volume increased by about 2%; productivity increased by about 15%; and continuity increased by about 45%. In addition to improving these metrics, the clinic ended the practice of canceling patients due to staffing shortages. Instead, coverage was provided for all scheduled patients and all walk-in patients have been accommodated. Conclusion: Although greater success is predicted over time, data trends already indicate a large improvement after implementation. Every member of the Adult Medicine clinic team has had a chance to participate in the changes and most of the feedback has been positive. The result has been a marked improvement in the flow of patients through the clinic and significant improvements in staff satisfaction.