Strengthening the links of care: How the implementation of care teams in an outpatient setting has improved workflow and allowed staff to provide better and more comprehensive care

Background: Metropolitan Hospital Center has put a lot of effort into the implementation of care teams across the outpatient department. Care teams help to spread work around; they also help build trust between physicians, nursing staff, and clerical staff, eliminating the need for unnecessary checks and balances on other roles. Together, these changes to work flow allow care teams to accomplish more patient care in less time. Care team members can focus on new functions like care management and pre-visit planning. In addition, care teams can enhance patient continuity by expanding the traditional patient-physician relationship to include other staff as well. Methods: Metropolitan Hospital Center has utilized a number of means to implement care teams in primary care and several specialties, including Neurology and General Surgery. Some funding for care team implementation has come from the Patient Centered Medical Home awards, and other work has been done using a structured, corporate-wide performance improvement methodology known as Breakthrough. At each step of the way, care team members have diligently collected data on their care team activities. Results: Primary care teams consist of an attending physician, three to four resident physicians, a medical assistant, a registered nurse (1 per every 2 teams), and a clerical associate (1 per every 4 teams). Physicians have begun performing direct discharges on average for 10% of the patients seen. This has reduced the amount of time required to discharge patients by nursing staff. In turn, nursing staff have been afforded the opportunity to perform pre-visit planning on 100% of scheduled patients. During this time, they make sure that all necessary laboratory and radiology tests have been done in addition to documenting any issues that will require the physician's attention during the visit. This has led to a reduction in unnecessary visits and ensured that patients are receiving the highest level of care possible. Care teams meet and huddle on a regular basis to discuss ongoing issues, performance improvement initiatives, staff call-outs and coverage, and relevant patient care issues like high-risk patients, no-shows, etc. Finally, by expanding the continuity of care from a patient-physician relationship to a patient-team relationship, Metropolitan Hospital Center has sustained continuity above 70% for the last year. Conclusion: Implementation of care teams across the outpatient practice at Metropolitan Hospital Center has improved workflow and allowed teams to focus on a single panel of patients, providing more comprehensive and streamlined care.