23 Oct Rx for Flu Shot Clinic = iPad
Today was the Big Day that both my staff and my patients have been dreading for the past few weeks: Flu Shot Clinic! Last October, Greg posted about our H1N1s clinics, which included one on Halloween. I thought we did a pretty good job last year, but we applied our “lessons learned” to try and make this year even better. And boy did we succeed!
As before, we prepared by pre-validating everyone’s insurance a few days ahead of time. We contacted families whose coverage had changed or lapsed so we wouldn’t have to deal with insurance cards during the clinic. For older patients getting shots from multi-dose vials, on Friday afternoon the nurses drew up approximately how many were expected to be needed. This was easy, because each visit was coded with a template for which type of vaccine would be needed. And the template coding was easy, because the patients did that themselves when they registered for the clinic on our web site.
Based on last year’s experience, we decided to schedule patients at a rate of one per minute. Even with 6 hours of time available, over 350 appointments filled in a matter of days. In fact, the first 200 slots filled within 24 hours of our email blast! To avoid bottlenecks at that pace, we decided on the following game plan:
- Patients arrived to announcements in the waiting room with the questions that impact whether their children could be vaccinated today. They read these sheets before checking in so they were prepared to give appropriate feedback quickly.
- Greg and I handled check-in. Just to add a tiny element of danger, we performed this task on iPads, which delighted many of the children and their parents! At a practical level, this gave us mobility if lines developed (which they never did) and avoided the need for monitors and keyboards and mice all over the waiting room.
- Upon confirming which type of vaccine was desired and medically appropriate, my partner Karen gave each child a sticker so the nurses could later identify which kind to administer.
- The patients walked back to the nursing area, where they rotated to the next of three available exam rooms where a nurse was waiting. By this point, Greg or I had opened an encounter, whose template had triggered a standing order for the correct vaccine. The nurse could see this task on the schedule, so she simply administered the ordered vaccine, placed it on the patient’s chart, and then marked the visit as “checked out.” Our iPads up front were set to “exclude checked out patients,” so the next batch of patients to arrive was always right at the top of the screen. I took special delight in watching the list shrink over the course of the day. Fred (Ptylak) is right: On a busy day, it is exciting to watch yourself reaching the end of the tunnel!
- One of the strongest pediatric features of Office Practicum is its vaccine management. As soon as the nurse recorded the vaccine on the chart — which only required a notation of which body site was used, because everything else is pre-populated — the correct entries for the vaccine and admin codes were dropped on the patient’s superbill. In addition, the vaccine was automatically added to the list to be reported to the Pennsylvania IIS.
- Throughout the day when no one was actively checking in, Greg turned superbill charges into claims. At lunch, he sent the entire morning’s activity to our clearinghouse. At the end of the day, he sent the remainder, at which time he got back acknowledgments for the morning. Rejected claims? Zero! Thank goodness for pre-validation.
By 4:00 we had administered 325 vaccines in just over six hours. The system never slowed down, and no one was in the office longer than 5 minutes. I believe we could have easily handled 50% more volume without missing a beat. By 4:15, everything was put away, every claim was out the door, every vaccine had been reported to Harrisburg, and it was “lights out.” There is literally nothing left to do on Monday.
Thanks again to my excellent staff, who worked all day like a well-oiled machine. Thanks to Wawa for the coffee that kept us going. And thanks to OP for proving once again why there is value in having a pediatric-specific EHR!