followup visits ... labs - before or after ?

[peter90036]

if i get labs at f/u visit
- i have to review results another day, and chart again-since i might not remember pt
- call pt back to discuss change in plan
- have RN call pt for normals (do many do this?)

if i get labs before f/u
- i have results at visit and can make decision(s) = more efficient use of time, but
- pt has to come in 2x
- they could cancel the visit and just call up for results


... what is your approach ?

---

Members don't see this ad.

 

[VA Hopeful Dr]

if i get labs at f/u visit
- i have to review results another day, and chart again-since i might not remember pt
- call pt back to discuss change in plan
- have RN call pt for normals (do many do this?)

if i get labs before f/u
- i have results at visit and can make decision(s) = more efficient use of time, but
- pt has to come in 2x
- they could cancel the visit and just call up for results


... what is your approach ?

Depends on your patient population. My office is mostly unemployed Medicaid, so I do the 2 visit approach. If my office had a decent percentage of working people, I'd do the labs a few days before the appointment.

 

[cabinbuilder]

In a perfect world I would do the labs before -especially diabetics- and they would come in to discuss them

 

[deleted87716]

If the patient is coming in for chronic disease management, and the medical decision-making will be based in part on lab results (e.g., lipids, HgbA1c, etc.), they have their labs done prior to the visit. To do it any other way is a waste of everyone's time.

 

[deleted87716]

Refill all of their prescriptions during visits, as well, with sufficient refills to last until their next regularly scheduled follow-up visit. If you are diligent about this, you'll hardly ever have to deal with refill requests in between visits.

 

[VA Hopeful Dr]

Refill all of their prescriptions during visits, as well, with sufficient refills to last until their next regularly scheduled follow-up visit. If you are diligent about this, you'll hardly ever have to deal with refill requests in between visits.

This should be bolded, all caps, and reposted about 3 times. I'm not very good at this yet and it annoys the hell out of me.

 

[cabinbuilder]

If the patient is coming in for chronic disease management, and the medical decision-making will be based in part on lab results (e.g., lipids, HgbA1c, etc.), they have their labs done prior to the visit. To do it any other way is a waste of everyone's time.

Exactly, how can you adjust insulin, or cholesterol meds without and A1C and a lipid panel? Or check renal function in a diabetic or HTN patient without a BUN/CR? I agree with blue dog, it's a waste of time to not have labs. I have made people reschedule if the labs aren't done prior since I know nothing without them.

 

[simpler2]

Depends on your patient population. My office is mostly unemployed Medicaid, so I do the 2 visit approach. If my office had a decent percentage of working people, I'd do the labs a few days before the appointment.

Absolutely depends on patient population. In my FQHC world, I do whatever I can...do what can be done with in house labs, often have to interpret fasting labs on non-fasting patient, limit labs I do order, and accept more than the standard interval between labs in some cases. We all develop our preferences and habits in clinical care but it is good to be flexible in these. I do think if you operate in absolutes all the time then you only irritate yourself, your patients or both.

 

[MJB]

In my ideal world, I will have labs done week prior to seeing patients in hopes of being more efficient.

This is not even worth trying in our residency however. Even if the patient is up for it, the lab usually manages to screw it up somehow.

 

[brats800]

I try to have my labs done prior to the visit for all routine follow ups. I usually order the next set of labs (for 3, 6, or 12 months out etc) at the time of the visit. I usually release the labs to their online EMR access (MyChart on Epic) if they are signed up, so they already know what we will be talking about when they come in. They know they need to be seen ~yearly for follow up chronic diseases in order to get their refills. Does this always work? Of course not. But it does make things faster and I would bet it increases patient satisfaction as they have all data and answers to their questions when they see me in person.

 

[Bacchus]

I ask they be done beforehand, but this isn't always possible.

For the patients who sporadically come to care (and should be seen more frequently) I'll get labs at their first visit after a 1, 2 or 5 year hiatus (seriously?). Luckily I haven't had any patients come in with such hiatuses, at this point in residency, who have had an MI, CVA, etc. It's bound to happen; I am sure.

I prefer the labs before the next visit; however, printing out the order almost always guarantees it will be lost and the labs won't be performed. Maybe I can do a QI project where an RN reviews charts for upcoming patients and mails out orders. Oh wait, this is a residency office... we're understaffed to begin with. I wish we had a phlebotomist or MA in house dedicated to lab draws; it would be more than convenient. Currently we will draw labs on patients we know will have difficulty getting to one of the network labs or Quest.

 

[deleted87716]

We all develop our preferences and habits in clinical care but it is good to be flexible in these. I do think if you operate in absolutes all the time then you only irritate yourself, your patients or both.

I have no problem with irritating people for the right reasons.