VA Primary Care Clinic

Functions of the PCC

The staff of the Primary Care Clinic (PCC) seek to provide ongoing comprehensive care and preventive medicine. Providers include staff physicians, general internal medicine fellows, a clinical scholar, a staff psychologist, psychiatry residents, medical residents (first, second and third year), nurse practitioners, and social workers. In addition there are RNs, LPNs and administrative support staff

Scheduling

Follow-up patients usually receive half-hour appointments with the PCC staff and R-2s, R-3s, and 45-minute appointments with R-ls. Transfer patients (those patients being transferred from one PCC provider to another due to turnover, patient or provider request, etc.) are scheduled for a 45-minute slot. All patients who are being scheduled for their first visit receive a one-hour appointment. Clinic appointments are scheduled on the hospital's core computer. If changes are necessary regarding your clinic availability, please submit a written notice to the clinic manager at least 4 weeks prior to the change. This allows the administrative staff enough time to reschedule the patients.

Medical Record

All patient notes, laboratory tests, X-ray requests, specialty clinic consults and prosthetic requests are entered in the Consolidated Patient Record System (CPRS) by the provider. Training for this program will be provided on the first clinic day. Additional assistance may be obtained by contacting the Clinic Manager or your Team Coordinator. Patient charts will, in most cases, be available for the appointment. Charts are ordered by clinic clerks prior to appointment. If chart does not show up for a clinic visit the clerks and/or team coordinator can sometimes track it down.

Clinic Procedures

The daily schedules are posted in the hallway and on the Triage Room door. At the start of each month, a monthly schedule, indicating patients and appointments, will be provided by your Team Coordinator. These schedules will be put into PCC mailboxes.

At patient check-in, the appropriate paperwork is completed by the clerks, vital signs are done by the clinic nurse, and the chart is placed on the shelves located in each hallway. At peak visit times it is the provider's responsibility to check and see if scheduled patients have arrived at the front desk for appointments. If vital signs have not yet been taken, please help by providing this function yourself after communicating this to our clinic nurse and front desk.

Providers see patients and complete an Encounter Form which includes a checkout list to guide the clinic clerk in scheduling future appointments, ordering tests and arranging referrals, as well as a prescription sheet for ordering medications not already listed on the "Action Profile" form generated by the computer to accompany the visit. When completing the Encounter Form, and medication profile it is important to remember to:

• Service connected question must be completed by provider (you simply indicate by marking yes or no as to whether the services provided at this visit were to treat the patients service connected disability)

• Cross-out unused space on prescription sheet to prevent unauthorized use. Non-formulary drugs require a new drug request. For most non-restricted drugs, a 3-month supply with 3 refills (i.e., 12 months total) may be prescribed.

• Retain the progress note and enter clinic notes before inserting it into the outpatient record. Be sure to sign it and include the last four numbers of your SSN/Social Security for ID purposes.

• Besides obtaining patient records, the clerks process Encounter Form orders, answer the telephone, take messages, make arrangements and confirm appointments by telephone. Providers are encouraged to utilize their direct phone mail.

Please help the clerks maintain a clinic which functions smoothly by utilizing a "Front Desk Request Form" completed and returned to their mailbox (lower right) for any special requests you may seek their assistance with.

• Keep personal phone calls to a minimum. Inform co-workers in other areas of the hospital of your schedule to minimize incoming calls asking if you are here, taking messages, etc. Leave your phone number if you can be reached elsewhere. Please refer incoming calls to the 4-digit extension number on your phone in the room you are utilizing. Indicate how long you may be reached at that location.

• If you are going to be late to clinic, please call and inform (contact them via pager) your team coordinator / clinic manager.

• Please be attuned to how busy the front desk clerks are, and wait your turn for assistance.

• Please note room schedule posted and inform clerks of your comings and goings.

Test results are returned to the provider's mailbox in the PCC. Mailboxes should be emptied each time you are in clinic so as to keep informed about your schedule, notes from patients, and other matters requiring your attention.
The clinic nurse will assist with simple office procedures such as IM injections, wound cultures, skin scrapings, joint aspirations, emergency EKG tracings and ear irrigation.

PCC and PEC schedules for the current month are posted on the bulletin board, as are room assignments and amendments to the daily routine. The attending physician for each half-day session is posted in each ~ hallway as well as listed noted on the daily calendar as the "star doctor" for the am session and attending for the pm clinics or for residents/nurse practitioners seeking MD consultations.

If you have any questions about clinic operation or require any assistance, please do not hesitate to contact the clinic manager at ext. 62960, Dr. Lipsky (Clinic Director), at ext. 61640, or Dr. Takahashi (Resident Teaching Coordinator), at ext. 65219.

There is a reference library in the conference room. Please feel free to use it . The accordion file contains handouts on ambulatory care topics prepared by PCC staff: Also, current PDR's and hospital formularies are available.

Please note the locations of the utility room and crash cart. The Team Coordinators/Clinic manager will give you the door's combination.

Patient Referral and Disposition

The PCC is open to veterans who are seen as new patient referrals. Those administratively eligible are placed on a waiting list chronologically by the date of referral. Residents on VA wards may refer patients to their own panels for continuity follow-up by entering a consult into DHCP and alerting their Team Coordinator to process appointment.

Patient panels for continuing care residents are transferred as a group, from one year's providers to the next.

Other Ambulatory Care Services

Anticoagulation Clinic - This is a service for patients requiring long-term oral anticoagulation therapy. All new patients are to be referred to Connie Browne, A.R.N.P., ext. 63879 for approval prior to scheduling into the clinic. An electronic consult to Anti-Coag is then entered into CPRS. Continued follow-up by a provider in PCC or other medical clinic is necessary.

Psychology/Psychiatry Services – Routine requests for psychiatric medication evaluation or psychological services require an electric consultation submitted to Psychology/Psychiatry in CPRS. Urgent care consultation requests can be made by paging Brad Felker at 570-2782 or contacting the psychiatry resident on duty in the clinic. Your Team Coordinator will be able to tell you who is on duty and their pager number. If there is no resident on duty, contact Dianne Greenberg at ext, 61343 or pager 570-2836.

Social Work Service - Each team in the PCC has a Social Worker assigned for individual, conjoint, and group consultation for social and some psychiatric concerns, family conferencing, finances, living situation, social adjustments, casework service, placement assistance (i.e., nursing home, adult foster home, adult foster home, retirement center, etc.). Enter an electronic consult for routine issues. Your team coordinator can give you their pager number for emergent problems.

Weight Management Group - Intended for patients in need of support and guidance in weight reduction. Send an electronic consult to Nutrition Outpatient, attention Dori Omori, who will schedule the patient into a time-limited weight management group.

Shot Clinic – Injections are given by the LPNs, Monday through Friday, for PCC patients. Patients are given appointments in the Team LPNs clinic. However, patients may also be given immunizations such as tetanus, pneumonia or flu in conjunction with their appointment with a provider. Orders for on-going immunotherapy such as testosterone or B-12, must be renewed on an annual basis.

Education

PCC Journal Club, Wednesday 7:30 - 8:30 am from September - June. Topics are designed for general internal medicine health care providers are chosen at the discretion of the scheduled speaker. Interested personnel are welcome and invited to attend. Residents on clinic block rotations are strongly urged to attend PCC Journal Club as their schedules permit.

Consultation and Attending - One PCC staff physician is designated as the attending physician for each half-day session, he/she will be available for patient management consultation with responsibility for resident and nurse practitioner teaching, and he or she may be asked to write prescriptions for other PCC staff members who are not available during that session. All PCC attending are available for consultation and can normally be found in the PCC Conference Room. There will be a teacher attending regularly assigned for residents during afternoon clinics.

Tutorials in Ambulatory Care Medicine are held at the beginning of clinic sessions for residents attending clinic on those days. Plan to attend pre-clinic conference sessions at 1:00 pm when you are scheduled for clinic daily Monday, thru Friday afternoon. The role of attending physician for R-l, R-2 and R-3 Continuity Clinics rotates through the PCC staff daily.

PCC Meeting

PCC staff meetings are scheduled on the third and, if applicable, the fifth Wednesday of the month at 8:30 am. Clinic problems and topics of general interest are discussed.

The first Wednesday of each month are designated as group PCC meetings involving all practitioners. The second and fourth Wednesdays of each month are designed as Team meeting dates where specific concerns/issues are discussed. These meetings are at four separate locations concurrently, (RAINIER: PCC Conference Room 18/241B/CASCADES: Primary Care Conference Room 1/227/ OLYMPICS: PCC Conference Room 18/241A/ MT BAKER: PCC Staff Lounge 18/262) all ambulatory care personnel are welcome.