Businesses often advertise checklist inspections to encourage customers to enter for services. For example, an auto repair shop may offer a free “50-point engine inspection.” In some cases, the inspections are offered complimentary or used when a customer has already entered for services. This is an example of prevention and early detection of problems; and, to be honest, of increasing business.
Similar checklists are used in healthcare. Cancer and spinal screenings are examples of measures that encourage initial contact for prevention, early detection – and in some cases, business promotion.
Checklists are also used in business to ensure proper order and safety of procedures. Lockout / tagout procedures are used in industry to prevent machines from starting during maintenance work. Procedures here include identifying the equipment’s energy source, locking out the source/equipment, tagging it as being in repair/should not be started, and verifying the process has been performed.
In healthcare, the time-out procedure prior to a surgery is a good example of efforts to ensure proper order and safety. Just before the start of surgery, a member of the surgical team calls, “Time out.” The team then identifies the patient, the procedure to be performed, the side of the body the procedure will be performed on (if applicable), whether the correct imaging is available, and other key factors.
I have used the checklist concept in my practice over the years. I once titled my initial physical examination “The 50-Point Spinal Checkup.” I advertised this and directed the patient’s attention to the concept during the exam.
Currently, we (my interns and I) use a checklist for daily patient visits. The checklist consists of seven primary points.
Point #1: Assess Pain
Point one is assessing pain using the Numeric Pain Rating Scale (NPRS) and the Pain, Enjoyment, and General Activity Scale (PEG). All components of both assessments are measured on a 0-10 scale, with zero indicating no problem and 10 indicating a severe problem. Pain measurement on the NPRS carries over to the PEG score. The numbers for each component are then averaged for the final result.
The PEG Scale is becoming increasingly more standard in healthcare practice. I practice in a multidisciplinary environment that includes pain management providers. Their notes always include PEG assessment.
Point #2: Evaluate Improvement
Point two is asking the patient about signs their condition(s) are improving, We rely on the 12 primary indicators listed below. Other indicators may be present, but we feel the factors on this list are the most important:
- Improved quality of sleep
- Increased mobility
- Decreased pain / pain score
- Forgetting pain
- Decreased use of medication
- Return to typical daily activities
- Return to work / school
- End of modified work duties
- Return to exercise
- Decreased use of home therapies (ice, brace, TENS, heat]
- Decreased anxiety
- Improvement in the areas of transportation and travel
Point #3: Is There Concurrent Care?
Point three is to inquire about other care the patient is or will be receiving. Is the patient seeing another provider in any field, receiving other ongoing care, or scheduled for any tests or procedures?
Point #4: Outline the Plan
Point four involves the patient’s understanding of their treatment plan and visit schedule. This, in turn, prompts a reminder for the patient’s next visit. We do not use treatment plans relying on a specific number of visits or a set amount of time. We use a benchmark system that adapts as patients meet specific criteria throughout their care.
Point four is used to remind patients of treatment goals and to maintain a consistent appointment schedule. It is our job to keep care on track.
Point #5: Are They Exercising?
Point five concerns exercise. We inquire about the patient’s recent exercise involvement to determine whether they are involved in activities they should or should not be.
Early in practice, I had to beat patients over the head to get them to exercise. Now, most patients exercise or want to exercise. In some cases, I now have to beat them over the head to get them to stop or alter their exercise regime long enough to heal.
This is especially difficult with patients participating in activities that involve rotating among multiple forms of exercise. There is an element of addiction/obsession for these patients. Discussions of exercise restrictions often become negotiations. If restrictions are assigned to the patients, they attempt to negotiate time periods or for replacement exercises.
(This is a problem area in the seven-point office visit; office flow can be interrupted by the time required for the negotiations.)
We also check the exercise we prescribed to the patient for their care at this point. We determine whether the patient is following the regimen as directed. Actual exercise instruction is provided outside daily visits, in another part of our facility.
Point #6: Answer Any Questions
Point six addresses one of the most common complaints listed by patients: not having their questions answered. This complaint is second only to complaints over waiting time.
We simply ask whether the patient has any questions, then record and address them. This proves to be one of the best points, as patients realize I am listening and care.
Point #7: Survey Satisfaction With Care
Point seven is closely related to point six. We survey the patient’s satisfaction with their care. This might be an especially difficult point for inexperienced providers. Many doctors are afraid of what they might hear. In reality, like point six, point seven is very effective.
We are interested in patient satisfaction with their overall care from the beginning through the current visit. There will be the occasional tough conversation, but most of the time, it provides a great opportunity for the doctor and staff to receive and relish positive feedback.
Practical Takeaway
At first, the seven-point office visit process may seem time-consuming. However, when some points have been addressed, they may not need reassessment on every visit. For example, care by other providers and exercise activities may not need day-to-day assessment.
I hope the above encourages you to review your daily patient visits and other procedures to enhance efficiency, safety, feedback, and effectiveness.
