A peer-reviewed, evidence-based journal that promotes clinical development and metabolic insights in total bariatric patient care for the healthcare professional
Issue link: https://bariatrictimes.epubxp.com/i/245728
Bariatric Center Spotlight Bariatric Times • January 2014 PATIENT ADHERENCE AND LONGTERM FOLLOW UP Our patients adhere to a specific postoperative follow-up schedule. We set that expectation up front and call to remind patients of their appointments one day prior. In addition, we schedule the patient's next appointment at the time of check-out. As we are following these patients for life, there will always be another appointment to be scheduled, even if it is their next annual appointment. For patients who miss appointments, we call and reschedule them. In addition, we are currently in the process of contacting each and every patient that has not been seen within the last year via a letter from our surgeons. We are requesting that they schedule their next follow-up appointment within 90 days of receipt of the letter. So far, we have had a good response to these letters. We find that when patients begin to feel that they are doing well on their own, they tend to slack off on their follow-up appointments. Ultimately, this can lead to weight regain in the long term and then patients are hesitant to come in and see us, perhaps feeling as if they have "failed." We feel strongly that if patients are committed to keeping each and every appointment, and staying plugged into the support groups and our online message boards, they are much less likely to stray from the guidelines for success. We stress to each patient that even when feeling great, he or she should still continue to be monitored. This is a life-long commitment and we recognize that patients will need our support for life. OUR EQUIPMENT AND NEW TECHNOLOGIES The latest technology we have implemented is a bariatric app for smartphones. The BariApp® is an innovative way for our patients to "stay in touch" with the practice. We provide the app for no fee to our patients. The app is HIPPA compliant and is patient focused. Patients have direct access to support group calendars, can request appointments, monitor their daily progress, join our fit challenge, download recipes, and ask questions to our dietitian and nurse. Patients rave about it and it is a great way to market our program. After much research, we chose to implement a bariatric specific EMR. This system is a "plug and play" EMR specific to bariatric medicine. The program is internet based, so we are able to access it from anywhere. We have found the program to be intuitive and easy to use. For example, a workflow can be changed or adjusted simply. No programming skills are required by the end-user, and it is easy to customize to our needs. This EMR also provides reporting that clearly shows you where there may be bottlenecks in your pipeline and where your referrals are coming from (or where they are not coming from), so that marketing dollar decisions can be applied without guesswork. We also provide testing for measuring patients' metabolic rate so that they gain understanding and knowledge of the amount of calories needed to stay within their daily caloric budget. The test is painless and quick. The patient breathes into a specially designed and calibrated breath machine. This test allows us to accurately provide a patient's daily calorie intake to encourage weight loss or to maintain current weight. Our retail store is stocked with bariatric specific products to ensure our patients have access to the highest quality vitamin and mineral supplementation and meal replacement options. We have a long-standing relationship with Bariatric Advantage® (Aliso Viejo, California) as we believe their products are excellent, in that they truly maintain proper micronutrient levels in our patients. We like Bariatric Advantage because they offer a complete line of products and meet the needs of our patients on all nutritional levels. COST AND EFFICIENCY We continually monitor and create new opportunities to increase revenue and decrease overhead. We have partnered with cardiology, lab, and psychology companies to bring these services in-house. This increases patient satisfaction as they can get everything done under our roof, and it also helps with increasing revenue. Some of the most simple costs reducers can easily be overlooked. We encourage staff to turn off lights in exam rooms and office when not in use. Before ordering supplies, we ask staff to empty their drawers of paper clips and pens for reuse. Reducing overhead is not that difficult, you just need to be creative and think simple. PATIENT ASSESSMENT We have created a complete pathway to determine patient appropriateness for surgery that begins with our call center. Patients are lightly screened during this call to ensure body mass index meets criteria. We perform this initial screening so that patients whose BMI does not meet criteria can be redirected to our medical program. We are sensitive to making sure patients get the right service so that we are not wasting their time. Once patients view the webinar, patients are seen in consult with the surgeon. Both the patient and the medical staff complete an assessment intake. This assessment covers everything from weight history, previous surgical procedures, psychological history, medications, and typical daily food intake lists. This history is reviewed with the patient by the surgeon, and candidacy is then determined for the appropriate surgical procedure. 15 PATIENT AND STAFF SAFETY The Davis Clinic was designed and built for our bariatric patients. Our exam tables and chairs are made specifically for bariatric patients and the exam rooms are large enough for any mobility issues/devices that patients use. All of our staff members undergo annual education on proper body mechanics and patient sensitivity. We also have protocols and policies to follow in the event of a patient fall. STAFF TRAINING John Primomo, Dr. Garth Davis, and Dr. Robert Davis pose for a picture. All employees are required to attend a patient webinar and a support group and read the patient manual upon hire no matter what their role within the office. We even offer the opportunity for the employee to view a surgical case if he or she wishes. All employees must view our sensitivity training presentation as well. No matter what the role, all new hires The waiting room at The Davis Clinic. shadow a person in each department so they have an overall understanding of the roles in the office and how important each and every one is for the success of the patient and the success of The Davis Clinic. We have dedicated staff members to answer telephones but all staff members are trained and expected to assist with answering phones to An exam room at The Davis Clinic. ensure patients that call our office are taken care of in a retail store, an onsite psychologist, and efficient and timely manner. Our a licensed dietitian. We believe in medical assistants shadow and are holding our patients hands through the trained by our certified bariatric nurse entire process of improving their health. and are given a test yearly to ensure Whether they choose surgery or patient safety and quality patient medical weight management, all outcomes. Employees are also given a patients matter and deserve and get our extensive overview of the required vitamin and mineral supplements of the complete commitment. Our knowledge, patients so they can assist the patient in our empathetic and attentive staff, and our multidisciplinary approach to the purchasing products from our retail store if necessary. In summary, we are a patient makes us a leader in our field We are very proud of what we have team and our goal is to make the built and continue to build at The Davis patient process safe, precise, clear and Clinic. easy for the patient. A UNIQUE FACILITY What makes The Davis Clinic unique is our approach to customer care and satisfaction and the full service we provide as a private multidisciplinary practice. Our philosophy is to provide the highest quality care for the patient under one roof. Every aspect of our clinic designed with our patients in mind. When we designed the space, it was important that patients could easily access our office. Our office is on the ground floor so that patients can literally drive right up to the front door. We offer all services, including an onsite laboratory , cooking classes, support groups, back on track classes, behavior modification classes, medical weight management, fitness training, a FUNDING: No funding was provided. DISCLOSURES: The author reports no conflicts of interest relevant to the content of this article. AUTHOR AFFILIATIONS: Jamie Carr is the Executive Director , The Davis Clinic, Houston, Texas. ADDRESS FOR CORRESPONDENCE: Jamie Carr, BSN, RN, CBN; Executive Director, The Davis Clinic, 929-B Gessner Road, Suite 106, Houston, TX 77024, Phone: 713-464-6000, E-mail: jamie.carr@thedavisclinic.com