What are three ways in which a patient information packet can be helpful to the medical office?

The role of a medical assistant involves educating patients in general office information, promotion of health and wellness, injury prevention, and presurgical education. Educated patients want to be involved in treatment decisions, and by involving them, patients are more amenable to following a treatment plan.

Education can also reduce anxiety and fear patients may have for a procedure or treatment. Those educated patients will be happy customers and likelier to tell friends and family about their pleasant experience with the physician’s office.

There are a few methods to educate patients including factual, sensory, and participatory teaching. The medical assistant will have different methods of printed and virtual educational materials to educate patients.

In addition, a physician’s office may have a general information packet to explain many of the administrative matters involved in scheduling and billing.

Finally, education of the patient by the medical assistant involves health and wellness, injury prevention, and presurgical instructions.

Patient Education Methods

Education and instruction methods can come in many forms including verbal, written, and demonstrative. There are different methods of learning when it comes to educating patients in a medical office, including factual, sensory, and participatory.

Using a combination of all three methods of learning can help patients get a full understanding of the instructions that pertain to a procedure or regimen.

Factual Teaching – Factual teaching methods inform patients of details of a procedure, surgery, or regimen so they know what is going to happen and how they should prepare. Factual information is supported by written materials for the patient to refer to after the initial conversation.

Sensory Teaching – This method involves a description of the physical sensations patients may feel during the procedure. For example, patients may experience soreness or pain following a procedure that is common and not an issue. The medical assistant will want to focus on all five senses, including touch, sight, hearing, taste, and smell.

Participatory Teaching – Participatory teaching involves a demonstration of methods to confirm that patients understand the treatment or procedure they will be a part of. After educating patients about the treatments or procedures they may need to do at home, it is important for the medical assistant to have the patient repeat the specifics of the treatment or procedure to confirm that they understand how to complete tasks.

Patient Educational Materials

The educational materials that a medical assistant will use to educate patients and their families can be either printed or virtual. Examples of educational materials include brochures, visual representations of a patient performing a task or doing some form of stretching, videos hosted on the physician’s website or located on YouTube, and patient resources provided by different medical organizations.

Many physicians’ offices use brochures and educational materials to explain procedures performed or to give information about specific diseases and medical conditions. Also, the use of electronic health records helps create, revise, and deliver the educational materials directly to the patient.

Information that is used to educate patients should focus on what the patient needs to know and why. It should also offer some expected results, warning signs for the patient to watch out for, problems that may occur, and contact information for the physician’s office should the patient have any questions.

The Patient Information Packet

During the first visit to a physician’s office, a medical assistant will typically educate the patient about the practices and policies of the office. By distributing an information packet, the patient will develop a level of trust with the practice and staff.

Some of the administrative matters that the patient information packet will explain include an introduction to the office and staff, the qualifications of the physician, a description of the practice, office hours, appointment scheduling, late or no-show fees for appointments, telephone policies, payment policies and late pay fees, insurance policies, and patient confidentiality statements.

Promoting Health and Wellness

Medical assistants can help promote health and wellness of their patients through educational methods that focuses on healthy habits, protection from injury, and preventative measures to decrease the risk of disease or illness. Patient education in the physician’s office should help patients to achieve these goals.

Healthy Habits – The medical assistant, with order and guidance from the physician, can educate patients to employ proper nutrition, get regular exercise, avoid smoking and drugs, limit the amount of alcohol consumed, practice safe sex, and create a healthy work/life balance.

Preventative Measures – Patients need to know that they can reduce the risk of contracting certain illnesses and diseases by taking preventative measures. Preventative measures include health promoting behavior, screenings, and rehabilitation.

The medical assistant will want to educate patients about health promoting behavior by living a healthy lifestyle and knowing the signs and symptoms of diseases. Regular screenings are important to identify any problems while they are in their early stages, catching an illness or disease that can be rectified with minimal damage to the patient’s body.

If the patient already has an illness or disease, it is recommended that the medical assistant educate the patient about rehabilitation. The goal of rehabilitation is to maintain functionality and avoid further disability.

Patient Education Methods Prior to Surgery

It is important for a medical assistant to properly educate a patient prior to surgery to reduce risks, prepare the patient, and create a positive outcome after surgery. This education involves preparation for the surgery and postoperative care after the surgery.

Properly educating a patient prior to surgery can also release the physician’s office from legal liability. Part of the education prior to surgery involves the patient’s signing an informed consent form for the physician.

Preoperative education can help reduce patient anxiety and fear, educate for the proper use of medication, educate about complications that may follow surgery, and improve recovery time. Educating patients about what to expect during and after surgery will allow them to prepare both physically and emotionally.

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Copyright © 2011, Baylor University Medical Center

At Baylor Jack and Jane Hamilton Heart and Vascular Hospital, we developed a preadmission packet that is given to patients before their procedure date, enabling them to complete much of their paperwork in advance. The results of our subsequent study revealed that nurses save time during the assessment interview when patients arrive at the hospital with their admission database forms completed. In a busy facility with a large number of patients admitted daily, the nursing time saved can translate into a substantial economic benefit. Even more important, however, is the benefit to patients, who feel less rushed and provide a more thorough and accurate medical history when they can fill out the admission database form at home.

In the hospital, the nurse-patient relationship usually begins with the assessment interview, a process that requires nurses to communicate and interact effectively with patients. Nevertheless, this initial assessment, which is a recurring and constant feature of a nurse's work, competes for the nurse's time with other demands such as patients' needs, doctors' orders, and a nursing philosophy that emphasizes individualized patient care (1).

In a busy facility with a large number of admissions each day, the pressure on nurses to complete the required paperwork—while still being thorough and accurate—can be tremendous. In our “increasingly litigious culture of hyper-regulation, health care providers feel pressured to focus on documentation rather than the administration of care” (2). There has been a dramatic increase in paperwork, which is often repetitive and duplicated (3). In fact, acute care nurses spend approximately 25% of their time completing paperwork (4), a task that has been cited as the most unsatisfying part of nursing because it takes time away from patient care. With increasing emphasis on efficiency and effectiveness in today's health care systems, management of a nurse's time is a very important consideration (5). Although the implementation of electronic medical records (and related devices intended to improve information access) is changing the amount and duration of nursing activities, the impact of this new technology on nursing care delivery is open to question (6). Regardless of whether paper-based or computer-based documentation is used, finding ways to enhance nurses' efficiency so they can spend quality time with their patients remains a priority.

At Baylor Jack and Jane Hamilton Heart and Vascular Hospital, we are planning to implement an electronic medical record system. Our current admission process, however, requires nurses to manually fill out three pages of admission database (ADB) information about the patient's history and health assessment. We have a high volume of patients to safely prepare for procedures, so it is crucial that the database is thorough and complete. Nurses frequently spend time waiting for patients to think through their surgical and medical histories, and they often find that the patients have forgotten important elements. Time is lost during this process and, more importantly, information is missed because patients cannot recall their history during the interview. To make the admission process less stressful for patients and to help improve efficiency and accuracy, we have developed a preadmission packet that is given to patients before their procedure date.

In an ongoing collaboration to improve patient care, our hospital staff and administration worked with our partner physicians and their office staff to develop the preadmission packet. To make the packet an attention-getting item that is hard to overlook, we chose a large, bright pink envelope to house the following items: instructions; the ADB and related admission forms (10 pages total); a “Safety First” sheet for documenting diabetes, anticoagulant use, implantable devices, and allergies to latex or shellfish; a patient checklist for the day of the procedure; a map to the facility; a booklet about the facility; two letters from hospital administration; and information from the patient's physician. The packet helps patients in two ways: it preemptively addresses their questions and concerns, and it allows them to complete the ADB form at home.

The preadmission packets are assembled every 3 months by patient transport staff (during their downtime) and are distributed to physicians' offices. Patients who are scheduled for surgery or a procedure receive a packet in person at their physician's office or by mail from the hospital's scheduling office. Hospital staff members call patients the day before their procedure to confirm their arrival time, give them further instructions, and inquire about any special needs or concerns. This information is shared and discussed that afternoon at an interdepartmental staff meeting.

Upon arrival, patients are asked if they have brought their packet and their medications with them; access services (admissions) staff members record the responses. Each patient is given a room assignment and is directed to the admission floor, where the nurse asks for the packet. When the ADB form has already been completed, the nurse can quickly review the information, act on it as needed, and ask clarifying questions instead of spending time on irrelevant or repetitive questions. If the patient reports a chronic condition (diabetes, for example), the nurse can explore this history more thoroughly by asking about compliance with medications and diet and about any symptoms that may be related to the condition. This interaction can allow a more in-depth discussion, with subsequent teaching. After reviewing ADB forms and completing any missing information, the nurse puts the pages in the chart for reference throughout the patient's stay.

To evaluate the effectiveness of the preadmission packet, we performed a study to answer two questions: 1) Do nurses spend less time on the assessment interview when patients complete their ADB forms in advance? 2) If time is saved, what is the potential economic benefit to the hospital from this reduction in nursing labor?

After learning about the admission process from nurses on the study team, the statistician based the sample size calculation on the hypothesis that it takes a nurse, on average, 8 minutes less to review a complete ADB form than to fill out an incomplete form. A small pilot study suggested that the ratio of complete to incomplete forms would be 11:8. Consequently, for the study to have a power of 0.8, we needed at least 22 subjects in the complete group and 16 subjects in the incomplete group.

The potential subjects were patients who received the packet prior to their hospital admission day and who were admitted during the 10-week study period. The study nurse collected data as her workload permitted during that time frame. She examined the packets of 67 subjects upon admission to determine whether all necessary ADB information had been given; each subject's form was then categorized as complete or incomplete. (Patients routinely leave nonapplicable questions unanswered [e.g., about vaccines, elimination, coping with stress, etc.], so those particular answers could be blank and the form would still be considered complete.)

The study nurse reviewed and/or completed the ADB information with the 67 subjects in their assigned patient rooms according to usual daily procedure. To eliminate possible bias, this interaction was discreetly timed with a stopwatch, and the subjects were not informed about the timed evaluation. Staff members were told to avoid interrupting the evaluation, and a sign on the door discouraged intrusions. If any interruptions occurred, the subject's chart was eliminated from the study. Other than being timed, the assessment interview (and subsequent patient care) was the same for the subjects as it was for patients who were not in the study.

The study was approved by the institutional review board. We secured all subject data in a locked office and destroyed all patient identifiers when the study ended. Of the 67 subjects whose assessment interviews were timed, 51 (76%) met our inclusion criteria and provided data, exceeding the minimum required sample size of 38.

Of the 51 subjects, 26 (51%) provided complete ADB forms, and 25 (49%) provided incomplete forms. There was no association between form completion and the type of procedure the subjects underwent (Table ​1, P = 0.132). The null hypothesis of this study was that nurses would spend, on average, an equal amount of time on the complete and incomplete forms.

Relationship between type of procedure and group category

We used a two-sample t test (type I error rate of 0.05) to compare the average times the nurses spent on the assessment interviews for the two groups (Table ​2). Specifically, Welch's t test was used because the variances between the two groups were not equal. As the small P values indicate (P < 0.001), nurses spent far less time when the subjects' forms were complete than when they were incomplete.

Time spent on assessment interviews for the two groups

Our hospital admits approximately 7200 patients per year. If each patient used the preadmission packet to provide complete ADB information, a total of 820 hours of nursing work time would be saved (410 seconds × 7200 patients ÷ 3600 seconds per hour), which translates into $24,108 saved when the median nursing salary is used in the calculation.

A more conservative estimate still yields an economic benefit. If the minimum nursing salary is factored in, use of the packet would save as much as $17,220 per year in nursing labor. Even if only 50% of the patients filled out the ADB information completely, $8,610 in nursing labor would be saved (or could be redirected to quality patient care) instead of being spent on paperwork.

Successful implementation of the preadmission packet has been a coordinated effort among many individuals and departments, including transport services, access services, the scheduling office, nursing staff, administrators, physicians' office staff, and, of course, patients.

Although this study focused on the time and nursing labor saved when the packet is used, this strategy has other notable advantages:

• Patients are given useful information about what to expect at the hospital, which can lessen their anxiety and help answer their questions.

• Patients can complete the ADB form in private at home, where they are more relaxed and are able to look up their medical history more readily.

• Nurses are provided with valuable patient information that allows them to individualize care and arrange needed consults (dietary, smoking cessation, social work, etc.).

• Staff members are able to spend more time on patient care than on forms, enhancing job satisfaction.

As Hospital President and Chief Nursing Officer Nancy Vish summarized, “We put this program in place to get better, more thorough data from patients, who oftentimes felt rushed and failed to tell us about a surgery or even diagnosed diabetes! This process allows them to think and be comprehensive. The nurse still reviews, asks questions, and signs off, but we are asking more detailed questions rather than just completing a form.”

Although we will be moving to an electronic medical record, utilizing a modified preadmission packet will be in our plans, as this tool continues to serve as a way of obtaining a more accurate and thorough patient history and physical. Over time, we will explore options for allowing patients to fill out this tool online. For now, the paper-based method works well and does not require computer skills or computer access. The preadmission packet has proved to be a win-win strategy for patients and the nurses who care for them.

The authors thank Brenda Poil, RN, ADN, for her work in developing the preadmission packet, and Beverly Peters, MA, ELS, a private consultant, for editorial assistance.

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