Increasing Patient Access and Quality of Care in a Nurse Managed Clinic

By Cynthia “Cindy” Feltner, RN, and Deborah Matosky, APRN

From the time of injury to the time of discharge, trauma patients are in a whirlwind of care delivery. This may include assessment by teams of unfamiliar providers, extensive imaging, and intrusive procedures. While essential to excellent care delivery, this can be overwhelming to patients and their families. When severe injuries are factored in, this can also increase apprehension about final outcomes. Discharge planning can add to patient/family trepidation about home care and follow up.

Prior to June 2017, the Miami Valley Hospital Outpatient Trauma Clinic format included full-time nurses and two afternoon clinics per week, allowing brief encounters with rotating APRNs. This format was useful in years past when length of stay in the hospital was longer. However, with changes in the health care environment, there is now greater emphasis on the outpatient recovery period. The clinic was restructured in June 2017 to meet these needs. Through collaboration with the trauma program nurse manager, the medical director, the current clinic nurse, and a key APRN, a new format for patient care was developed.

The changes included transferring a full-time APRN to the clinic, and expanding clinic hours from two afternoons a week to four full days. Previously, patient appointments were 10 minutes per patient. With this new format, appointments now last 30 to 45 minutes, depending on the complexity of injury. This allows for thorough review of all injuries and provides time for questions from patients and their families. Patients also occasionally express new areas of discomfort that need further evaluation, which may turn up missed injuries.

Continuity of care by the same clinicians has increased patient satisfaction and comfort level with familiar care givers. This has been evidenced by an increase in positive patient feedback. Another benefit of this format is time allowance for care coordination with other outpatient services to better meet the needs of rehabilitation for our patients. Collegial relationship between the two clinic providers has increased job satisfaction and productivity in this work environment.

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