Project Plan Overview

PROJECT PLAN OVERVIEW

Georgia Neurology and Sleep Medicine Associates is a multispecialty, single physician practice which specializes in providing medical care to adult patients experiencing neurological and/or sleep disorders. The staff consists of the owner/physician, one nurse, one nurse practitioner, three front office staff personnel, and one office manager. Since its open in March of 2001 the patient volume has already increased by more than 35%.

Problem Statement

Although the growing patient volume is good for business, the ability to provide services for new and returning patients in a timely manner has been minimized. The practice is currently able to schedule the physician to see a maximum of 20 patients per day, Monday through

Friday, 9:00am to 4:00pm. "Extended waiting times and delays between appointments have plagued healthcare systems for years" Murray, 2003, p.13). Currently a patient visit consists of check in at the front office, the nurse takes the patient to a room and takes vitals, the nurse practitioner evaluates and diagnoses symptoms, and the physician reviews the evaluation, confirms or changes diagnoses, treats and/or discharges the patient with a prescription to check out.

Because there is only one physician in the practice there is a limited ability to treat patients daily during established operating hours. The physician in the practice, would like to increase the ability to service and treat more patients daily, increase revenue, and decrease the waiting period for new and return office visit appointments; without adding a physician to the practice.

Project

The project allows the nurse practitioner to evaluate, treat and discharge patients from an appointment without seeing the physician first. "The training of nurse practitioners qualifies them to take a medical history, perform physical examinations, identify medical problems, interpret laboratory results, and instruct, counsel and prescribe medications for patients" (University Medicine Foundation, 2003, para 1). During this trial period, both the physician and the nurse practitioner would have a separate appointment schedule to evaluate and discharge patients. The trial would end six months from the start date, at which time the results would be analyzed to determine whether the new process should become permanent or should be ended.

According to Physician's Computer Company (n.d) "with the proper organization, nurse practitioners can see many of the routine visits (be it for well care or common illnesses) allowing the office to see more patients" (www.pcc.com). The mission of the practice is to provide specialized, thorough and quality medical care for its patients. If the project is successful, it is expected to increase the quality of care by affording patients faster and frequent care as well as increase profit for the practice. Mark Murray, M.D. (2003) says, "Delays in care can also adversely affect clinical outcomes: lengthy waits lead to delays in diagnosis and treatment and can prevent the timely delivery of recommended preventive services" (p. 13).

Scope

The project objective is to make appointments more excessible to patients, reduce appointment visit time spans, increase patient volume without overextending the physician, and to increase profits. The project patient appointment schedule allows both the physician and the nurse practitioner to have a patient rouster. The trial period should begin one week from the proposed date and should be completed in six months. The cost of the project should not exceed $30,000.00.

The project should increase the amount of patients being seen daily by at least 50% because both the physician and nurse practitioner will be seeing patients at the same time period. Growth in the patient volume would increase the practice's daily income and the ability to treat patients more quickly and frequently. Once primary care physicians are aware that there is more appointment availability for their patients needing to see a specialist for neurological or sleep disorders, an increase in referrals to the practice is also likely.

Utilization of exam rooms will also increase as both the nurse practitioner and physician would be seeing patients at the same time. Additionally, actual appointment visit times should be minimized as the extra amount of time previously used for both the physician and nurse practitioner to see a patient would be elminated. Judy Capko, (2003) a consultant in Thousand Oaks, California states, "Wait time in the exam room indicates whether you're efficiently utilizing clinical space" (Weiss, 2003, p. 75).

Patient and referring physician satisfaction is also expected to increase if waiting periods during visits and to schedule an appointment to be seen would be shortened. According to Weiss (2003) "patients who have to wait too long may start shopping for another doctor" (p. 75). An increase in the correlation between the quality of service being provided and the patients perception would also be expected.

There are however some constraints on the new schedule being implemented during the trial. New patients to the practice and those patients being seen to have a procedure performed must be seen by the physician; therefore, all appointments which fall in those categories must be scheduled with the doctor. A Medical Degree (M.D.) is required in order for a clinician to be ethically and legally allowed to perform a procedure. A nurse practitioner's training and certifications do not cover the performance of a procedure; therefore, a physician would have to treat any patient being seen for such a service. Insurance carriers do not allow physicians to refer a patient for treatment to a nurse practitioner; therefore, initial visits to a medical facility must be performed by a physician.

In order to assure quality care is still being provided, the physician will review each of the patient charts seen by the nurse practitioner at the end of each day to check for discrepancies or misses in evaluations. A log of check in and check out times per patient, per physician, will also be kept at the front desk for evaluation at the end of each month to assess wait time changes.

Idle time for front office staff should be decreased as the in and out flow of patients will become more frequent with two clinicians operating at a time instead of one. Additionally, the time the nurse's services are being utilized should increase as she will be taking more patients to a room per hour than those taken back on the previous schedule. The new project schedule is however expected to