Foundations of General Practice : A workbook for nurses
Supporting systems and processes
Set up systems to ensure the clinic is running efficiently
On this page:
Develop a responsive and flexible appointment system that accommodates patient and staff needs
Create processes to manage patient recalls and reminders
Understand your data-management and privacy obligations
Booking and billing systems
Development of a responsive and flexible appointment system that accommodates patient and staff needs, requires thoughtful consideration of some of the following factors:
the nature of the service proposed (e.g. longer pre-booked consultations versus walk-in appointments)
development of strategies in events such as staff illness to ensure continuity of care
development of procedures in relation to visiting patients in their homes
development of procedures for care of patients outside working hours, and
culturally appropriate care provision.
The availability of appointments to suit the needs of the consultation is an important factor in providing a patient-centred approach to nursing care.
Once you have defined your process, you’ll need software and equipment that supports it. Consider whether your patient cohort might benefit from automated online appointments (‘self service’), ensure your system is able to be supported by your staff, and seek advice from existing clinics about their experiences.
You’ll need billing policies, processes, hardware and software set up. If you’re integrating with an existing service, your organisation probably has an existing billing system in place. If not, here are some things to consider:
Understand the Medicare billing processes and options
Consider how you will bill clients
Develop a system for recording MBS items claims and other income.
Reminders and recalls
Recall systems ensure patients receive further health advice on matters of clinical significance and are associated with the provision of quality care.
Reminders are used to initiate prevention with patients who may benefit from participating in appropriate health promotion and preventive care activities or who may require appropriate and timely review of their treatment and/or their medical devices. Reminders can be either opportunistic or proactive.
Recalls are a proactive follow up to a preventive or clinical activity and are designed to facilitate patients receiving further medical advice in relation to matters of clinical significance.
This depends on the probability that the patient will be harmed if further medical advice is not obtained, as well as the likely seriousness of the harm. While not every test or referral needs to be confirmed, if there is a reasonable suspicion of a clinically significant outcome, then the doctor has a duty to attempt to follow up and recall the patient. Inadequate follow-up and recall may jeopardise the patient’s healthcare and place the responsible doctor(s) at medico-legal risk.
Depending on your nurse clinic, you may implement a systems approach for reminders. For example:
Diabetes annual cycle of care
Asthma cycle of care
Eligibility for home medication review
Information management systems have a strong association with quality of care. Read more about this here
A patient register is a searchable list of patients that are within the target group for the nurse clinic. They are is important to record services provide, recall patients, book appointments, document activities, record results and track progress. Registers may be electronic (such as clinic software), paper based or a combination of both. Maintenance of registers needs to be accurate and up to date, in order to provide effective care.
Data information and management
The electronic collection, use and management of client and system data for clinical and administrative decision-making is crucial to the current and future success of nurse clinics. Your nurse clinic will be involved with and dependent on data. Health care decisions are driven by the analysis of data, therefore the quality of data is paramount.
Data is collected at multiple points of contact with patients. It starts when patient demographic details are recorded at reception and continues through clinical assessment and ongoing management processes.
Safe and effective health care is dependent on patient data being useful, accurate, accessible, consistent and current. Identifying patients in specific population groups, delivering evidence- based care, providing accurate referrals, ensuring continuity of care and measuring health outcomes— all depend upon accurate data.
Data, information and knowledge
The clinical information held within health records is relied upon to accurately reflect a patients’ health status, and the delivery of quality health care is an information—dependent process. The driving force behind good quality data is ultimately to support patient safety through appropriate clinical management based on the best information available — high quality information means better patient care and better safety:
- high quality data is meaningful, accurate and consistent
- poor quality data affects patient safety and quality of care
- maintaining consistent data quality is a challenge
Improving data quality is not the sole responsibility of one team member.
Do you need to clean your data?
Data cleaning helps to accurately determine the number of active patients under the care of the organisation, and who may be recruited to the nurse-clinic. This involves inactivating non-current patients, removing sample patients, marking deceased patients, and assigning gender.
How will you identify patients at the nurse clinic vs the rest of the organisation?
In your software you may need to use a specific code for your clinic. Avoid using free text
How will you collect data for your clinic? Will you use your existing organisation’s clinical software?
What reports can you generate from your software to track the progress of your clinic?
Read more about the importance of data here