Developed by the Hannibal Regional Hospital Diabetes and Wound Ostomy Center as part of the Better Self Management of Diabetes program, funded by the

Transcription

1 Developed by the Hannibal Regional Hospital Diabetes and Wound Ostomy Center as part of the Better Self Management of Diabetes program, funded by the Missouri Foundation for Health.

2 BSMOD Organizational Change

3 Change in referral process Change in process will decrease the length of appointment wait time. Physicians concerned regarding excessive wait time to see the Diabetes Educators. Centralized schedulers workload attributing to hardship in making contact with patients in a timely manner. Average wait time for appointment was 2-3 weeks.

4 DIABETES CENTER PHYSICIAN CERTIFICATION FORM (OLD FORM) Name DOB Phone: (Home) (Work) Cell Address: Physician 1. Reason service is needed for in-depth and intense individualized training New diagnosis of Diabetes Poor Glucose Control Ketoacidosis Frequent or Severe Hypoglycemia other 2. Date of completed history and physical Diagnosis Type Uncontrolled Type Type Uncontrolled Type Gestational Prediabetes Date of Diagnosis Other (renal, etc) HgbA1C Date Fasting/RandomBG Date Diabetic symptoms Ο No symptoms List any changes from previous condition that would warrant training Patient compliance/commitment to diabetic condition Good Fair Poor Individualized plan of care & goals Better controlled diabetes A1C<6.5% Foot care instruction Eliminate symptoms FBS<120 Weight loss Insulin instructions Urine Ketone monitoring Other Treatment intervention to attain the goals (including frequency and duration): Nutrition Education (diet); Exercise Instructions: Initial visit with nurse Visit 2 with dietician 2 week follow up with dietician, 1 month 3 month 1 Year follow-up Any physical limitations: SPECIAL NEEDS FOR 1:1 SESSIONS DUE TO IMPAIRMENT OF: Visual Hearing Language Other Self blood glucose monitoring: Frequency 1x/d 2x/d 3x/d AC&QHS Other Please list current medications; Date: Physician Signature: PLEASE CALL TEMPUS SCHEDULING AT TO SET UP APPT. FAX THIS FORM TO DIABETES CENTER THANK YOU. FOR QUESTIONS CALL

5 Old process Physicians orders faxed to Diabetes Center. Diabetes Center faxed orders to Centralized Scheduler Department. There was not a clear process for prioritizing patient contact.

6 Process Change Referrals called to Centralized Scheduling while the patient is in the office. Physician orders are faxed directly to Centralized Scheduling.

7 DIABETES CENTER PHYSICIAN CERTIFICATION FORM (New form) Name DOB Date: Diagnosis: Type Uncontrolled Type Type Uncontrolled Type Gestational Prediabetes Medications: Oral Hypoglycemics Lab results (required) Other Medications FBS HgbA1C Other 2hr Postprandical BS Cholesterol LDL HDL TG Insulin (check all that apply) Units Frequency 70/30 Blood glucose monitoring Humalog Lantus Type of meter Levemir Regular Frequency BID QID NPH 1x dly TID Other DIABETES SELF-MANAGEMENT TRAINING Initial Group: 9 hours, 4 sessions over 6 months All patients must attend a group class unless on of the following is present, then an individual training is provided. (check all that apply) 1 hour session Vision impairment Cognitive Dysfunction Hearing Impairment Other Follow up group training: 2- hour session. Available to patients yearly after first year of diagnosis Insulin Administration only: 1 hour session Medical necessity: (one required, check all that apply) New onset diabetes Poor glycemic control as evidenced by two consecutive A1C levels three months apart Wide fluctuations in glycemic levels resulting in ER visits or hospitalizations. Lack of feeling in feet or other foot complications Retinopathy or kidney complications DATE: PHYSICIAN SIGNATURE: PLEASE CALL PATIENT SCHEDULING AT TO SET UP APPT. FAX THIS FORM TO SCHEDULING THANK YOU. FOR QUESTIONS CALL

8 Added changes Schedulers were educated on new referral process. Calendar created for Group Classes. Initial patient call to be made within one business day. Designated one scheduler to be responsible to contact Diabetes Center patients. Physician office to be notified if unable to contact a patient with in 5 working days.

9 Challenges to change Initially the Physician offices were concerned regarding contact with schedulers per phone. Schedulers concerned regarding increased number of phone calls. Diabetes Educators concerned regarding not being notified of referrals.

10 Addressing Challenges Met with Physician s nurses to discuss and educate regarding the proposed process. Met with Centralized Scheduling Department discussed the proposed process. Part time scheduler hired to assist with all centralized scheduling needs. New referral automatically faxed from Centralized Scheduling to the Diabetes Center.

11 Success New process in place. Increased physician satisfaction. Increased patient satisfaction. Average wait time for an appointment decreased from 2-3 weeks to 3-4 business days.