Physician’s Office: Successful Outcome Using TeamSTEPPS Techniques

Karen Smith, Receptionist: Dr. Diaz’s office,
this is Karen. David Johnson: Karen, this is David Johnson.
I’m a regular patient of Dr. Diaz. Mr. Johnson: I woke up this morning feeling
weak. I’m wondering if I could see Dr. Diaz today? Karen: Let’s see. I’m sorry, Mr. Johnson,
but our schedule’s full today. I’ll let his nurse Renee know, and we’ll get back in touch
with you, okay? Mr. Johnson: Okay. Please have her call
me back as soon as you can, Karen. Karen: Renee, David Johnson called for
Dr. Diaz this morning. He said he woke up feeling weak and wanted to see Dr. Diaz. Our schedule’s full this morning. Can I move
Mr. O’Conner’s checkup to next week and have Mr. Johnson come in at 10? Renee Jones, RN: So he says he’s feeling
weak. Did he say anything else? Karen: Um. No. Renee: So we don’t know if he’s feeling
lightheaded, or if he’s in any pain? Karen: No, I didn’t ask him anything like
that. Renee: Karen, how am I supposed to make
decisions if I don’t have enough information? I’ve gotta go see my next patient. I have
to deal with this later. Karen: Renee, have you spoken to David
Johnson yet? Do we need to follow up with him? Renee: Oh my gosh, I never called him back.
Can I see that? Karen: Here you go, Renee. I don’t know
him, but he did not sound good. Renee: Dr. Diaz, do you have a moment?
I need to run down some things with you. Dr. Hector Diaz: Sure, Renee. But make
it quick. There’s a lot on my plate right now. Renee: Okay. First, can you sign these
scripts? Phyllis Mitchell wants you to refer her to
an orthopedist for her shoulder pain. Also, David Johnson called and said he woke
up feeling weak. You remember who Mr. Johnson is, don’t you? He’s a 68-year-old with hypertension and hyperlipidemia. We’ve had him on lisinopril 20mg daily for
the last year now, and you added hydrochlorothiazide 25 mg per day three days ago. He said he woke up this morning feeling weak.
Do you think we should see him today? Dr. Diaz: No, just tell him to stop taking
the hydrochlorothiazide. Renee: Dr. Diaz, I’m concerned about Mr.
Johnson. I called and talked to him, and it sounds like more than just weakness. He sounded
anxious and said he feels like his heart’s beating out of his chest. Dr. Diaz: You know, you may be right, Renee.
Let’s get him in today for an electrocardiogram and a blood pressure check. Renee: Okay, I’ll call him right now, and
I’ll set up an electrocardiogram and a blood pressure check. I’ll bring that to you as
soon as I have it. Thanks, Dr. Diaz. That’s right, Mr. Johnson. Dr. Diaz would
like to see you today, so we can run an electrocardiogram and check your blood pressure. Mr. Johnson: Should I be concerned? Renee: No, there’s nothing to worry about.
Dr. Diaz just wants to make sure that your weakness is related to the new medication
you’re taking, and nothing else. Mr. Johnson: I’ll be right in. Thank you. Renee: Okay, Mr. Johnson, we’ll see you
in about an hour. Hey, Karen, if you have a minute, we should
talk about a situation from yesterday. Things didn’t go as smoothly as we would’ve
liked, and I feel some responsibility. So let’s think about what we can do to make it
better. Karen: Sure, Renee. Renee: I was frustrated because the information
you provided was incomplete, and not helpful. Karen: I’m sorry about that, Renee Renee: Well, I’m sorry that we haven’t
provided you with the training you need. If we provide that for you, we’ll all benefit. Now, I know you’re new here, so here’s what
would be helpful next time. When a patient calls with a clinical concern,
ask some general questions, like the ones listed here. They’ll help us make sure the patient gets
the right care. Karen: Oh, this’ll be a huge help. Renee: Well, as you know, yesterday we
were able to help Mr. Johnson quickly. If we don’t ask the right questions at the
right time, we might not be able to help other patients as quickly as we should. I need you to speak up when things like this
occur. No one benefits if we don’t speak up or address
issues quickly. So let’s go through these questions. For example… Dr. Diaz: Thanks, Renee, for getting lunch
today. Let’s go over how things went over the last
week. The lab forgot to pick up the specimens, but
Karen caught it in time for the courier to deliver. We had five no-shows last week, and Renee
and I will be addressing that. And oh, yeah, we’ve heard that David Johnson
is home and resting comfortably. We did a great job as a team with Mr. Johnson’s
case. So, what do you think we did well, and how
can we improve our communications? Renee: Karen was very sensitive to Mr.
Johnson’s needs. As usual, I was swamped, but she kept me on
task by making sure I did my part to address his issue. Karen: I was concerned about Mr. Johnson,
but I realized that I could have gotten more information from him, too. Renee: Precise communication is one part
of it. The other part is training, and that’s my
responsibility. I hadn’t given Karen the training on what
to ask when people call with these issues. We need to do a better job of orienting our
new team members. Karen: Well, I really appreciate our conversation
last Wednesday. That was so helpful. Dr. Diaz: I think we need to make sure
that everyone’s comfortable speaking up in this practice. Getting those issues out of
the way helps us focus on the real work here. Karen: Like taking care of Mr. Johnson. Dr. Diaz: We all need to speak up, just
like Renee did. She challenged my orders and helped me refocus on the issue. I could’ve missed something if she hadn’t. We need to keep our communications open and
continue working as a team, not just as individuals working at the same place. Now, how else can we accomplish this?

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