The Executive Suite: Virtual connections drive clinical efficiency

It’s no secret that COVID-19 brought massive changes to the healthcare landscape. That holds true for most private practices, including the Diabetes Center in Ocean Springs, MS, a private practice offering treatment and education for diabetes care I opened 15 years ago.

As an adult acute care, board-certified advanced diabetes manager, and nurse practitioner (NP), I opened the clinic to serve a specific need in our community. I started as a solo practitioner before adding two nurse practitioners and a full support staff of medical professionals. Together, we actively monitor more than 5,000 patients. Mississippi operates as a collaborative model, which means each NP is required to have a collaborating physician. In accordance with state guidelines, NPs meet with physicians monthly to review charts and look at quality improvement. That protocol continued, despite COVID, through online collaboration and meetings—a relatively minor adjustment in the full scheme of keeping the practice going to meet patient needs during a pandemic.

Adopting flexibility in management

In my practice, each NP sees 18 to20 patients each day so the practice sees on average 40 to 60 people daily, which is significant for a diabetes specialty practice of this size. We created a streamlined patient flow procedure within our practice to ensure smooth, efficient patient movement and limit staff and patient exposure to airborne and direct-contact diseases. Our standard procedure includes collecting patients’ data at the front desk before escorting them to an exam room where we schedule their follow-up appointments. Following the exam, the patient goes to the NP’s office for a consultation. Our procedure removes the need to go back to a reception area or any additional check out area.

Like many other practitioners, I did the research and set up a telehealth program; however, my patients simply weren’t that interested in the option. Diabetes care is hands-on. I need to collect their lab work, download information off their glucometer, and collect downloads from their insulin pumps and glucose sensors. I need to touch and feel my patients, check their feet, and examine various other areas. While we tried to go virtual, most of our patients said they wanted to come in; therefore, I continue to see 98 percent of my patients in person.

Staying open for patient visits meant following state department of health guidelines and Centers for Disease Control and Prevention (CDC) protocol. As a result of those precautions, like so many other clinics, we faced challenges with staffing and remote access to information. Because we serve a vulnerable patient population, I’m adamant that our entire team takes extreme precautions and stays home if feeling even slightly symptomatic. As an example, we’re a total staff of 12 including only three NPs, so we’re careful not to eattogether anymore. I had to hire an extra front desk receptionist and an extra medical technician, and I retrained the whole staff to step into other roles to have the flexibility to take care of our patients should someone on our staff is not able to work due to illness.

Embracing remote technologies

Flexibility is one of the positive outcomes of dealing with pandemic protocols. Another is improving remote access, which is a big improvement for our clinic. If the patient uses a meter that can be connected via a smartphone or uploaded at home, we can see that data. If I’m seeing a patient quarterly and he has hyperglycemia, has been put on steroids, or has had surgery and is having trouble with blood glucose levels, I’d need to schedule an office visit to upload his meter on our system. Now, that’s not always the case. While we had the technology before, it’s now more accessible to use remotely.

As an example, in my practice, while A1C results provide great information, the data is not as helpful as knowing what is happening to the patient’s glucose levels every day. Being able to download 30 or 60 days of data from a glucose monitor or sensor provides more consistent, quality information. While that is specific to a diabetes clinic, other specialists and primary care practices can use blood pressure information, weight monitoring and others.

Taking advantage of learning opportunities

Remote access extends beyond the patient community to the staff with a surging interest in virtual learning. As a frequent industry speaker, I’ve seen more willingness to participate in virtual learning activities that provide opportunities to stay connected and to learn. Companies have pivoted and worked out ways that we could do this legally, still have a lunch break, and learn from each other, so why not embrace that? We’re working with companies that can't send product and pharmaceutical reps out into clinics anymore, yet these companies are working hard to pivot to get information to clinicians and continue to make connections.

Our online communication falls in line with what respondents to a 2020 survey of 153 NPs and physician assistants (PAs) said about how they are choosing to meet at this point in the pandemic. The survey by POCN, the country’s largest NP and PA network, said while 59 percent of respondents used conferences to receive information and education from life sciences companies, the overwhelming majority is open to communicating electronically through emails, journals, key opinion leader webinars and virtual visits. Forty-six percent even said they’re open to virtual video sales calls from those in the industry.

I often host remote presentations to other practitioners through POCN and advocate taking advantage of opportunities to learn from one another and from industry experts. Most people are used to Zoom meetingsand GoToMeeting, but in the medical world that’s not a regular communication tool we’re accessing. We're used to people coming to us and having a conversation or taking us to a dinner meeting, but times have changed. Despite the pandemic, brand new medications are coming out, techniques are improving, and there are great opportunities to embrace this way of staying connected and keeping up with information.

Persevering through unimaginable pandemic challenges showed me that I can maintain a successful practice by continuing to grow and learn—in part by participating in virtual communication and training endeavors with peers and colleagues through professional organizations such as POCN. Learn to be flexible and make sure you continue to take advantage of the options you still have to learn and adapt. People are under so much stress that accepting virtual opportunities can be efficient and effective.