A-01-MSC Revised: 3/91, 7/91, 4/92, 5/92, 7/94, 1/95, 1/97, 12/97

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1 Written: December, 1988 Revised: 3/91, 7/91, 4/92, 5/92, 7/94, 1/95, 1/97, 12/97 Medicine Specialty Clinic 1/99, 12/99, 12/00, 1/02, 2/03, 12/03, 3/07, 7/07, 3/08 Ambulatory Care Division 1/09, 2/10, 3/11, 12/12 LSU Health Sciences Center- Shreveport, LA Page 1 of 4 SCOPE OF SERVICE MEDICINE SPECIALTY CLINIC A. LOCATION AND HOURS OF OPERATION The Medicine Specialty Clinic is located on the 2 nd floor of the Ambulatory Care Center. Building. The clinic functions between the hours of 0800 and 1630 or until clinic is completed Monday thru Friday. B. SERVICES/CONDITIONS AND POPULATION SERVED The clinic provides consultative, diagnostic, therapeutic and referral services to patients ages childhood through geriatrics. CONDITIONS/DIAGNOSIS TREATED Anticoagulation Monitoring Cardiology Dermatology Endocrine Gastrointestinal Infectious Diseases Nephrology Pulmonary Rheumatology Viral Therapeutics (Hepatitis A, B, and C) C. PROCEDURES/ACTIVITIES PERFORMED Procedures performed in clinic include: Arthocentesis Blood glucose monitoring Cosyntropin testing, Fine needle aspiration IM Methotrexate Joint Injections Lumbar punctures Oxygen therapy Paracentesis Punch biopsy Skin Scraping Thoracentesis For a complete list of procedures see Policy: P-10-MSC in this policy manual. Procedures requiring general, spinal anesthesia or conscious sedation are not performed in the clinic. 1

2 Scope of Service Page 2 of 5 D. CLINIC STAFFING Medical staffing consist of Medical Directors, Staff physicians, Residents, Fellows, Interns and Medical Students. Nursing staff consist of 2 Registered Nurses, 4 Licensed Practical Nurses, 1 Nursing Assistant and 3 Clerks. Ancillary Staff consist of a Case Manager and intermittently a dietitian, Physical Therapist, Occupational Therapist, and Coordinators for Rheumatology, Nephrology, Cardiology, Pulmonary, Infectious Disease and Endocrine. E. NURSING STAFF FUNCTIONS The RN Clinic Supervisor A/B is responsible for 1. managerial duties 2. ensuring the proper functioning of the clinic 3. functioning as a staff nurse 4. maintaining a safe environment The Staff Nurse is responsible for: 1. IV therapy 2. blood transfusions 3. medication administration 4. chart review 5. patient education 6. patient flow 7. acting in supervisory capacity in the absence of the Clinic Supervisor 8. specimen collection 9. acting as a procedure nurse 10. maintaining a safe environment The LPN is responsible for 1. patient flow 2. catheterizations 3. medication administration 4. chart review 5. patient education 6. acting as a procedure nurse 7. maintaining a safe environment The Nursing Assistant is responsible for 1. assisting with patient flow 2. obtaining vital signs 3. assisting the physician 4. escorting and transporting patients to other departments in the medical center 5. ordering supplies from Central Medical Supply 6. assisting with specimen collection 7. maintaining a safe environment 2

3 Scope of Service Page 3 of 5 The Administrative Coordinators/Hospital Admit Technicians are responsible for 1. processing patients in and out of the clinic 2. ordering charts from medical records 3. answering the telephone 4. ordering supplies from the General Service Store 5. recording daily census 6. scheduling appointments in workqueue 7. assisting with patient registration 8. assisting with admission processes 9. maintaining a safe environment F. IMPORTANT ASPECTS OF CARE Important aspects of care include vital sign assessment, patient education, screening abnormal lab, performing blood glucose monitoring. High Volume: Management of patients with the following conditions or receiving medications: Aranesp Injections Asthma Chronic Kidney Disease(CKD) Chronic Obstrutive Pulmonary Disease (COPD) Coronary Artery Disease (CAD) Chron s Disease Diabetes Mellitus Gastrointestinal Prep Instructions for Endoscopic Procedures Hepatitis C Hypertension (HTN) Hyperthyroidism/Hypothyroidism Iron Deficiency Anemia Rheumatoid Arthritis (RA) Sarcoid Systemic Lupus Erythematosus(SLE) High Risk: Anticoagulation Atrial Fibrillation Blood Transfusions Lumbar Puncture Mitral Valve Prolapse Paracentesis Thoracentesis Thyroid Biopsy Thyroid Cancer 3

4 Scope of Service Page 4 of 5 G. APPOINTMENT SCHEDULING AND ACCESSIBILITY New patients are accepted by physician referral only. After consult is reviewed by physician in charge of clinic or designee and deemed appropriate, an appointment is scheduled by the Department Designee. The average waiting time is 1-4 months, depending on the patient's condition. All patients with a high risk condition/diagnosis will be rescheduled via automation after the 3 rd referring provider is contacted. The patient will have to call to be rescheduled. NO-SHOW FOLLOW-UP Patients unable to keep their appointment may contact the Department of Service for a new appointment. Patients who have a high-risk condition/diagnosis will be contacted by the Department Designee to return to clinic. Each Department will follow their individual guidelines for re-appointment. Rheumatology High-risk diagnosis/conditions for Rheumatology patients include active connective tissue diseases such as lupus, polymyositis, or scleroderma, active vasculitis or arthritis on immunosuppressive therapy. (Note: No-show patients are reappointed at physician's discretion. Other patients may be requested to call or write for return appointments at physician discretion). Endocrine High-risk Endocrine condition/diagnosis include any endocrine malignancy, pituitary tumor, thyroid module, adrenal insufficiency, thyrotoxicosis, Goiter, Hypothyroidism, Pheochromocytoma (Note: No-show patients are reappointed at physician's discretion; patient may not be reappointed after missing repeated consecutive appointments). Nephrology High-risk Nephrology condition/diagnosis include chronic renal failure, chronic renal insufficiency, nephrotic syndrome, post-op renal biopsy, severe, uncontrolled hypertension. No-show patients are reappointed at physician's discretion; patients may not be reappointed after missing three (3) or more consecutive appointments. If the patient is a one time no-show, staff will send a letter to the patient; the patient will need to call the department to reschedule. Gastrointestinal High risk Gastrointestinal conditions/diagnosis include patients with recent endoscopic procedures needing follow-up appointment, ulcerative colitis, Crohn s disease, colon polyps, colon cancer, GI bleed, ulcer, pancreatic cancer, ascites, hepatitis, hepatocellular cancer, chronic liver disease, esophageal stricture, pancreatitis, s/p liver biopsy, any patient on the following medications: Interferon, Prednisone, Imuran, and 6-MP. The Medicine Specialty Clinic Supervisor/Staff Nurse re-appoints as deemed necessary by the direction of the Department Chairman or Designee. 4

5 Scope of Service Page 5 of 5 Anticoagulation All patients who participate in the Anticoagulation Monitoring are considered high risk. If a patient is a no-show; the appointment will be automated. After the 3 rd consecutive no-show; the patient will be dropped from Anticoagulation Monitoring via a letter. The patient may contact the Medicine Specialty Clinic to reschedule and/or re-enroll. Other No-Show Patients All other no-show patients are reappointed by the Department's designee. Patients are contacted by telephone or mail by department staff. Established patients experiencing nonemergency problems may be seen with physician's approval during clinic hours or may be referred to the Emergency Care Center. I. ABNORMAL DIAGNOSTIC STUDIES FOLLOW-UP When the lab contacts the clinic regarding critical values, it is the nurse's responsibility to notify the patient's physician. The nurse then documents the action taken in the abnormal patient s EHR. It is the physician's responsibility to act on any abnormal results and determine the need for follow-up. J. PATIENT EDUCATION The physician is responsible for educating the patient regarding their disease process and treatment. The clinic staff provides education and instructions regarding procedures, medications, IVs, and diagnostic testing. 5