As MAs bring the patient back they should explain that they are going to an exam room to prepare for the clinician together. Once the patient is settled in the room, the MA should proceed to cover the four components of Robust Intake. The four components should be followed in order, but as MAs master the principle behind covering this information, they will learn that these areas can be covered in whatever order that makes sense, following the patient’s lead:
1.The Chief Complaint: The reason for the patient coming in today. This may be outlined from Visit/Chart Prep, generalized in phrases like “labs” or “follow up,” or left completely blank. The MA can state, “I see you’re coming in today for ____. Is that what you still wanted to be seen for?” If not, the patient is asked to describe the reason for the visit today. It is crucial that the MA is not logging into the computer or trying to take vital signs at the same time. The patient needs the MA’s full attention and this is the key time for the MA to look for signs of distress or anxiety. Part of the training for MAs is to teach them to recognize basic signs of discomfort in patients, like sweating, shakiness, fleeting gaze, unusual stutter, etc.
2.Negotiating the Agenda/Prioritizing Patient’s Needs: Many times a patient wants to discuss an issue other than the primary reason for the visit. Perhaps the patient is following up on an acute issue that has resolved, but is interested in discussing a chronic issue related to pain or another condition. Other times a patient asks to have healthcare maintenance needs addressed at this time, such as a PAP smear or yearly physical check. When not discovered as part of the Robust Confirmation Call conversation, this is often a difficult position for the medical team. Most providers want to address every issue the patient has at the time they see the patient; however the clock is always ticking and some issues require more than a one-visit treatment. Many attempt to “set the agenda” meaning to limit the patient’s list of needs. However, in a patient-centered model of care, the MA listens carefully to the patient discuss the issues and recognizes this is the time to begin noting those issues.
The MA may state:
“We planned to address your high blood sugars today and I’ll let the clinician know you need these medications refilled. We will need to make an appointment for your fasting lab work, PAP smear, and yearly physical examination as there won’t be time to address all of these items today and you’ve not come in fasting. I’ll let the clinician know about your back pain and see if she can make a decision today or how she can best address that for you.”
Keep in mind that the MA must relay all the mentioned issues and the information given to the patient as to when the issues will be addressed to the clinician upon exiting the room, through the 30-Second Report. This ensures that both the clinician and the MA are on the same page and gives the clinician freedom to re-prioritize or change what will be addressed during this visit. Being the ultimate medical decision maker, the clinician may change the order and what issues will be addressed today. In most cases, the physician agrees with the agenda set by the MA for this visit.
3.Outstanding topics: This is the time to ask about allergies, current medications, and preferred pharmacy, along with any other generic template questions. It’s also the time to address those other issues that will come up. During the course of Robust Intake other topics will (and should) arise, such as: current immunizations, pending labs or reports, or other unaddressed issues from previous visits. The MA should attempt to gather information about those issues. A way to do this is to simply ask the patient, “did you have those labs that we ordered a month ago drawn? I don’t see the results here.” Or, “It’s time for a flu vaccine again. Would you like one today if the provider agrees you can receive it?” Other outstanding topics may not be as easily addressed, but should still be on the MA’s radar. These topics include recent diagnoses, needs for educational visits with other healthcare personnel, or even more complicated visit scheduling, like in-office procedures or yearly physical exams.
4.Observations: This is perhaps the most important piece of Robust Intake. Often times we ask MAs to hurry during intake and don’t ask for their observation. As limited and brief as Robust Intake can be, observations are an integral part of the process. Important observations about the patient and relevant interactions with anyone else in the room are pieces of information that the provider must have.
The next step is for the provider and MA to connect about the gathered information before the provider enters the exam room. This is done as the 30-Second Report.