Who is responsible for what tasks within primary care: Perceived task allocation among primary care providers and interdisciplinary team members

Edwards, Samuel T.; Rubenstein, Lisa V.; Meredith, Lisa S.; Hackbarth, Nicole Schmidt; Stockdale, Susan; Cordasco, Kristina M.; Lanto, Andrew B.; Roos, Philip; Yano, Elizabeth M.

doi:10.1016/j.hjdsi.2015.05.002

Cited by 21 publications

(28 citation statements)

References 30 publications

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“…The task questions were developed by clinicians and social scientists with experiencing practicing and studying primary care at the VA, and the questions have been used in several published studies. 11,31,32 Composite Task Delegation/Reliance Score To generate a composite task delegation/reliance score, we calculated the mean of the scores for all respondents across all 15 tasks. We also calculated the mean task delegation/reliance score for each task and task grouping.…”

Section: Employee Perceptions Of Task Delegation/reliance and Discordmentioning

confidence: 99%

“…Early in the implementation of PACT, significant differences existed between PCP's and nurses' perceptions of responsibility for specific clinical tasks: PCPs reported they perform most clinical tasks alone, whereas nurses reported they were relied on for the same tasks. 11 However, these discrepant findings may have occurred because PCPs and nurses were surveyed separately, rather than analyzing responses from PCPs and nurses in the same team. In addition, it remains unknown how perceived task delegation relates to employee burnout.…”

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confidence: 99%

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Task Delegation and Burnout Trade-offs Among Primary Care Providers and Nurses in Veterans Affairs Patient Aligned Care Teams (VA PACTs)

et al. 2018

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Purpose: Appropriate delegation of clinical tasks from primary care providers (PCPs) to other team members may reduce employee burnout in primary care. However, (1) the extent to which delegation occurs within multidisciplinary teams, (2) factors associated with greater delegation, and (3) whether delegation is associated with burnout are all unknown.Methods: We performed a national cross-sectional survey of Veterans Affairs (VA) PCP-nurse dyads in Department of VA primary care clinics, 4 years into the VA's patient-centered medical home initiative. PCPs reported the extent to which they relied on other team members to complete 15 common primary care tasks; paired nurses reported how much they were relied on to complete the same tasks. A composite score of task delegation/reliance was developed by taking the average of the responses to the 15 questions. We performed multivariable regression to explore predictors of task delegation and burnout. Results: Among 777 PCP-nurse dyads, PCPs reported delegating tasks less than nurses reported being relied on (PCP mean

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Section: Employee Perceptions Of Task Delegation/reliance and Discordmentioning

confidence: 99%

mentioning

confidence: 99%

Task Delegation and Burnout Trade-offs Among Primary Care Providers and Nurses in Veterans Affairs Patient Aligned Care Teams (VA PACTs)

et al. 2018

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“…We have identified nine specific relationship‐centred communication skills that can be learned to promote a collaborative culture Teaching task work: competencies and learning strategies Task work competencies: ○Know, perform, and improve roles and responsibilities ○Verbalise team roles (both your own and those of team members) ○Perform your professional responsibilities, and state when y u cannot do this ○Accept the responsibility to improve care Learning strategies: Team roles The team can collaboratively prepare a checklist of clinical roles and responsibilities for each team member New team members or trainees can shadow other team members to understand their work roles Periodically reflect on how the team is working together Discuss ways to assist each other during busy clinic days Perform professional responsibilities Huddle: each day, the team can meet for 10–20 minutes to identify patient needs, to schedule changes, and to coordinate care Case conferences: periodic meetings with the whole team to reflect on challenging cases and to identify ways to coordinate care and/or learn new knowledge or practices Panel management sessions: with relevant team members, reflect on a registry of one care outcome for the team's patient panel (i.e. Haemoglobin A1c) and initiate plans to improve Improve care A workshop series to learn and apply the basic principles of quality improvement (QI) Identify team improvement needs related to measures of work processes or care measures Team meetings can provide a set time to identify and work on QI projects Promote a culture of safety by accepting mistakes and admissions of not knowing as opportunities to learn and improve

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Section: The Conceptual Model Of Primary Care Team Performancementioning

confidence: 99%

Teaching primary care teamwork: a conceptual model of primary care team performance

Warde

Giannitrapani

Pearson

2019

The Clinical Teacher

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Editor's note: Typically, in many countries, teamwork is a defining feature of primary health care delivery. Primary care settings are therefore potentially ideal places for health professionals to learn about and experience teamworking and collaborative practice. The authors of this toolbox article, based in California, USA, describe a model to help teach teamwork in the community based on the patient-centred medical home (PCMH) approach. The toolbox article includes details of the PCMH movement, with its focus on the continuity of comprehensive care and the building of personal relationships between patients and professionals. The model highlights the importance of team performance, inputs such as leadership and staffing, outputs such as measurable patient outcomes of care delivery, and the overall relationship-centred culture. Competencies and learning strategies are presented in a series of tables, including teaching meeting practices (the importance of regular meetings and how to ensure their effectiveness), task work (relating to team members' roles and responsibilities), and teamwork (trusted relationships and respected communication). The final table focuses on how educators can prepare for team performance training. Educators already involved in interprofessional learning and teamwork training will find much of this material familiar, but perhaps the different context will stimulate reflection on different approaches. Educators new to facilitating interprofessional learners and team development will hopefully find this toolbox article useful for planning and delivery.

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“…Responding to these prescription renewal requests requires a significant amount of clinician and clinic staff time. [1][2][3][4] Excluding requests during patient visits, primary care providers handle approximately 12 prescription renewal requests daily, which commonly include multiple medications. 1 Renewal requests require chart review to assess the patient's current and past medications and dosages and to determine that appropriate monitoring for side effects occurred.…”

Section: Background and Significancementioning

confidence: 99%

“…Each legacy standing prescription renewal order contained a header with metadata and general rules for the standing order. Rules included the requirements that (1) the medication had to be listed on the patient's active home medication list, (2) nurses could not renew controlled substances, (3) the patient had to have visited the clinic in the past 12 months, (4) the licensed nurse could only renew (not alter the prescription), and (5) medication, dose, route, frequency, quantity, and authorizing prescriber had to remain unchanged. After the general rules, each clinic's standing order then grouped medications authorized for renewal with specific renewal criteria for each group (►Fig.…”

Section: Background and Significancementioning

confidence: 99%

Rebuilding the Standing Prescription Renewal Orders

et al. 2019

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Background Managing prescription renewal requests is a labor-intensive challenge in ambulatory care. In 2009, Vanderbilt University Medical Center developed clinic-specific standing prescription renewal orders that allowed nurses, under specific conditions, to authorize renewal requests. Formulary and authorization changes made maintaining these documents very challenging. Objective This article aims to review, standardize, and restructure legacy standing prescription renewal orders into a modular, scalable, and easier to manage format for conversion and use in a new electronic health record (EHR). Methods We created an enterprise-wide renewal domain model using modular subgroups within the main institutional standing renewal order policy by extracting metadata, medication group names, medication ingredient names, and renewal criteria from approved legacy standing renewal orders. Instance-based matching compared medication groups in a pairwise manner to calculate a similarity score between medication groups. We grouped and standardized medication groups with high similarity by mapping them to medication classes from a medication terminology vendor and filtering them by intended route (e.g., oral, subcutaneous, inhalation). After standardizing the renewal criteria to a short list of reusable criteria, the Pharmacy and Therapeutics (P&T) committee reviewed and approved candidate medication groups and corresponding renewal criteria. Results Seventy-eight legacy standing prescription renewal orders covered 135 clinics (some applied to multiple clinics). Several standing orders were perfectly congruent, listing identical medications for renewal. We consolidated 870 distinct medication classes to 164 subgroups and assigned renewal criteria. We consolidated 379 distinct legacy renewal criteria to 21 criteria. After approval by the P&T committee, we built subgroups in a structured and consistent format in the new EHR, where they facilitated chart review and standing order adherence by nurses. Additionally, clinicians could search an autogenerated document of the standing order content from the EHR data warehouse. Conclusion We describe a methodology for standardizing and scaling standing prescription renewal orders at an enterprise level while transitioning to a new EHR.

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Who is responsible for what tasks within primary care: Perceived task allocation among primary care providers and interdisciplinary team members

Cited by 21 publications

References 30 publications

Task Delegation and Burnout Trade-offs Among Primary Care Providers and Nurses in Veterans Affairs Patient Aligned Care Teams (VA PACTs)

Task Delegation and Burnout Trade-offs Among Primary Care Providers and Nurses in Veterans Affairs Patient Aligned Care Teams (VA PACTs)

Teaching primary care teamwork: a conceptual model of primary care team performance

Rebuilding the Standing Prescription Renewal Orders

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