Primary Care Redesign: Utilizing a Team-Based Approach to Improve Patient Care and Decrease Care Team Workloads

Karyn Dionne-Quiros BSN, RN, RN-BC; Tomilola Akinfe DNP, RN, APHN; Samantha Styne MSN, RN, CPN

RUSH developed Primary Care Redesign to address the lack of standardized processes, which hinders patient care and increases care team workloads. Those involved in the initiative created — using a team-based model — a system meant to improve the health of patients and the clinical experiences of their providers and staff. The initiative led to new designs for interdisciplinary workflows after a combined effort among health care providers in Primary Care, the RUSH Access Center and Ambulatory Care Management.

Primary Care Redesign’s success came in large part from standardizing the Epic in-basket management workflow. Prior to Primary Care Redesign, inconsistencies in the communication methods used and the way patient messages were classified were common. This resulted in care team members routing patients to providers in a non-standardized manner, which led providers to spend a substantially greater amount of time during and outside of clinic hours addressing patient messages. Figures from in-basket data reports for July to October 2021 show that providers were spending 70 to 90 minutes daily outside of scheduled clinic hours reviewing and answering patient messages, which was in addition to the time spent on messages between patient visits during clinic hours.

To address this problem, RUSH conducted rapid improvement events (RIE) with multidisciplinary teams from departments that partner with Primary Care. The RIE results were used to gauge the barriers faced by care team members when they set out to develop patient-centered solutions that have a measurable and scalable impact. The collaboration and insightful feedback furnished by RUSH providers, nurses, clinical leaders, social workers and Epic information systems staff were used to develop a new standard of work (SOW) guide. The SOW outlines a streamlined process for categorizing, communicating and routing patient messages to providers while enabling care team members to flag patient messages according to their acuity — low, routine or high priority — and send encounters to providers as either actionable or for their information only. Now, providers can more readily identify encounters that require immediate attention and can better address patient needs promptly.

The SOW was implemented in October 2021, and marked improvements were quickly observed. From November 2021 to June 2022, the amount of time providers spent reviewing in-basket messages decreased by nearly 30 minutes — the data showed an average of 45 to 50 minutes. The new process for categorizing and filtering patient messages enables quicker review and swifter action (if needed), which had a positive impact on patients’ care and reports of satisfaction. Standardizing and refining workflows are important to the Primary Care Redesign, and continually improving our processes is instrumental in strategically addressing evolving patient needs and balancing care team workloads.