Emergency physicians spend more time looking for charts, finding lab reports, and checking if treatments are done, than they do caring for patients. After continual interruptions from allied health providers, patients, and other physicians, doctors have little time left for patients.
Some say scribes help. But after trying scribes, we found navigation to be our greatest need, not transcription.
Physician navigators (PNs) do 2 things:
Direct physician-patient traffic
They do not:
Make clinical decisions
Give clinical advice
Order clinical care
Team communication, especially between nurses and physicians.
PNs perform non-medical tasks that MDs do when working without a PN. They do anything doctors do that does not require a medical degree.
We use Physician Navigators to
- Keep informed of patients waiting in all areas of the department
- Find out which patients are waiting to be seen next
- Accept and photocopy patient handover lists from the physician handing over —
- Make sure all these patients are reviewed and looked after by the accepting physician
- Keep track of all the patients the doctor has seen and when patients are ready for reassessment
- Obtain chart for “next available MD to see”
- Access electronic charts; print out reports
- Prepare chart for MD reassessment: blood-work, x-rays…printed and ready to hand to patients at discharge
- Update MD data in the ED information system (tracking board)
- Page and receive specialist phone calls
- Receive and manage other incoming calls
- Hold non-critical calls for MD when MD is with a patient
- Assist RNs locating MD for urgent needs
- Inform patients about wait times and purpose
- Direct patients in and out of examining stations
- Update RNs on MD work plan
- Receive RN requests for patient reassessment
- Work with the team (e.g., RN and RT) to gather equipment for procedures
- Handout patient information sheets and referral forms to patients when instructed by MD
- Assist with paperwork to ensure proper completion
- Create handover list at the end of a shift
Physicians Navigators do this, and more, with good humour, a positive attitude, and in a polite, semi-invisible way. After a few shifts with a PN helping out, physicians never go back.
(photo credit: whatdoesceostandfor.com)