Ask the Expert Communication Series: Provider to Provider Communication
Q: How do shared medical appointments improve communication among and between providers?
“Gee, I do not know the best sources of plant sterols and stanols—Teller can you fill us in?” “I am not sure which yoga positions you should avoid with your high blood pressure, Shannon, can you help me with this?” “I am not clear about why you are getting these labs on Ms DeAngelo, can you explain it to us?”
These questions are examples from our lifestyle SMAs between me, our nutritionist Teller, and our exercise physiologist Shannon. In the course of participating in numerous SMAs, I have been surprised by the powerful positive impact this model has on communication among team members. Our team supports and learns from one another at each encounter.
We run a variety of SMAs, but the one that excites me the most is our lifestyle SMA. The goal of this SMA is to promote healthy lifestyle change to reduce cardiovascular risk among our patients. Virtually every patient in the lifestyle program is overweight, and many are inactive and have unhealthy diets. Most of these patients also struggle with one or more other risk factors, such as high cholesterol, high blood pressure, diabetes, or smoking. Some are trying to prevent their first heart attack; others, another one. Our job is to provide these patients with the tools to embrace healthy change.
We staff these differently than our regular SMAs. Our team includes a provider (me), an exercise physiologist, a nutritionist, and a nurse. Unlike typical SMAs, there is no behaviorist and no documenter. Instead, we all assume those roles. I might document while the exercise physiologist or nutritionist speaks, and the nutritionist might act as the behaviorist while I am focusing on a patient. By cross training and overlapping roles we are able to keep staffing lean.
This team really exemplifies the way in which providers learn in a SMA – both from patients and from each other. Because we all have unique information pertinent to the patient’s health, we each take the lead at different times. I have learned from the nutritionist and exercise physiologist about the different ways in which I can customize exercise prescriptions and modify nutrition, knowledge beyond my scope of expertise that adds value to the patient’s experience and enhances success. The experience working along side the other members of the team, instead of in sequence enhances me as a provider; I can apply what I learn to other patients whom I may be seeing in a traditional one-on-one appointment.
During an SMA I am reviewing labs, answering medical questions, adjusting meds, ordering tests, and scheduling follow-up appointments – and the other team members are a part of this. Because all of the team members are present, there are fewer errors because:
- We serve as a safety net for one another, clarifying things that are confusing and double checking orders for errors on the spot
- We all know what and how information is communicated to the patient about his/her care plan.
When the physician places an order, the team then checks it and clarifies any areas of ambiguity. Everyone knows what the order is, what the clinical question is, and why the test was chosen. This minimizes the communication that we have to have with each other later, because the decision making process is transparent. It also serves to provide a checks-and-balance system whereby we are all aware of outstanding studies so fewer fall through the cracks. This feature of SMAs adds value for the patient that is difficult to quantify, but is invaluable.
One measurable way in which improved team communication in SMAs has impacted our care is through a reduction in scheduling errors. We found that the percentage of patients scheduled for the necessary follow-up appointments and referrals was higher when performed by the SMA team than when done through the usual scheduling channels. SMAs significantly reduced scheduling errors we observe following one-on-one appointments and fewer patients get lost during follow-up.
About Amy Tucker
Dr. Amy Tucker developed and co-directs Club Red at University of Virginia Health System, a clinic designed use innovative delivery models to provide preventive care for women at increased risk for cardiovascular disease. Read more about Dr. Tucker here.