by adgrooms on December 5, 2019

The workload for physicians has compounded in the last decade with EHR documentation requirements. These requirements and EHR interfaces have contributed to higher instances of stress and burnout as well as increased waste for the entire healthcare system. The added burden is reducing bedside time that correlates with patients' quality of care and in some cases contributes to increased medical errors. CMS has introduced new rules to reduce the administrative burden on clinicians, but the effectiveness is yet to be measured. There is a solution being adopted mainly by primary care providers known as team-based care. It is a progressive model that removes the administrative tasks from the physician and puts them in control of care while a coordinator assumes documentation and communication responsibilities and guides the patient through the duration of their visit. So how does it work?

The patient receives a care team coordinator that takes all of the vitals, asks the basic interview questions about symptoms, history, etc., and records everything in the EHR. When the physician comes in to evaluate, the advocate remains to help facilitate the interaction. They give a complete rundown of the information collected so far and verify it with the patient. The physician can investigate further with the patient while the advocate enters information as a scribe. Once a diagnosis is determined and all of the physician’s instructions are recorded, the patient advocate makes sure any prescriptions and labs are properly ordered. They coordinate any specialist recommendations and see that the patient has all of their questions answered.

There are clear benefits for the physician and the patient in this model. The patient benefits from seamless care through the whole visit. Handing off patients between a nurse and doctor without a coordinator can lead to incomplete information from the patient. If the nurse or doctor is listening and scribing for themself, information can be missed. Coordinators can make sure that everything is documented, the patient’s needs are met, and the next steps (referrals, medications and instructions, and scheduling future visits) are set up correctly. The care coordinator also reduces waiting time between handoffs for the patient, shortening the visit and reducing stress.

The physician can enjoy increased efficiency while spending more quality time with the patient. This is an area that has been eroded with the increased administrative burden since the adoption of EHRs. The coordinator can have all of the patient information ready to review when the physician enters the room. The coordinator can give a rundown of the notes allowing the physician to absorb the information without having to read. The physician can then review the notes with the patient and give full attention to diagnosing and solving problems. Once the diagnosis and further steps are communicated, the coordinator goes on to take care of the details. The physician is off to the next patient in a fraction of the time compared to the traditional clinical workflow, with less multitasking and cognitive load. The physician is allowed to be focused on the job they are trained to do.

Adoption of the team-based model can be a positive step towards lessening the administrative burden placed on physicians, reducing burnout and putting the joy back into clinical care. Does your institution use team-based care? How is it working for the clinical staff and patients?