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Previsit Planning for New Patient in Pulmonary - Adult - Ambulatory [141]

Previsit Planning for New Patient in Pulmonary - Adult - Ambulatory [141] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Delegation/Practice Protocols, Ambulatory Delegation Protocols


Protocol Number: 141

Delegation Protocol Title:
Previsit Planning for New Patient in Pulmonary – Adult – Ambulatory

Delegation Protocol Applies To:
UW Health Adult Pulmonary Clinics

Target Patient Population:
New patients establishing care in the Pulmonary Clinic for the following indications:
• Asthma
• Chronic obstructive pulmonary disease
• Cough
• Dyspnea
• Interstitial lung disease or sarcoidosis
• Pulmonary clearance for surgery

Delegation Protocol Champions:
J. Scott Ferguson, MD – Department of Medicine, Pulmonary
James Runo, MD – Department of Medicine, Pulmonary
Nizar Jarjour, MD – Department of Medicine, Pulmonary

Delegation Protocol Reviewers:
Jennifer Bellehumeur, RN, MSN, CNS Medical Specialty Clinics
Kelly Ayala, RN, BSN – UWHC Pulmonary Clinic
Laura Zunker, RN, BSN, CCRN – UWHC Pulmonary Clinic

Responsible Department:
Department of Medicine – Division of Allergy, Pulmonary and Critical Care

Purpose Statement:
To delegate authority from the Pulmonary Clinic Provider to the Registered Nurses (RNs) and Medical
Assistants (MAs) to order radiology tests (CXR or Chest CT) and pulmonary function tests as previsit
planning for select indications.

Who May Carry Out This Delegation Protocol:
Registered Nurses (RNs) and Medical Assistants (MAs) in the Pulmonary Clinic who are trained in the use
of this protocol and who have documented completion of training and passed competency.

1. Each RN completes training as part of the onboarding process.
2. Competency is assessed as part of the orientation/onboarding process and annual.

Guidelines for Implementation:
1. The scheduler receives a request to schedule the patient, determines that the visit is for one of the
indications listed in Table 1 and sends an in-basket notification to the Pulmonary Clinic RN or MA
pool.
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org

2. The RN or MA reviews medical chart for any recent reported testing results and places necessary
orders (Table 1) and routes the orders to the appropriate provider for co-signature. Tests may be
performed before the orders are cosigned by the provider. If necessary, due to insurance or distance
from a UW Health facility, the RN or MA will fax or send the order to be performed at an outside
facility. Copy order out of order report from Health Link and send.
3. The RN or MA will provide patient with appropriate instructions regarding the tests to be
performed.
4. The RN or MA will route the encounter back to scheduler to arrange for appointments. Radiology
exams or PFTs done at UW Health should be scheduled to be performed immediately before
(adjacent to) the first clinic visit. The scheduler will enter all tests scheduled or to be done in clinic
before appointment in the appointment “notes” field in the Health Link schedule.
5. If the test is performed prior to the day of the visit and the patient does not arrive for the visit, the
MD or RN will notify the referring or primary care provider of the results (abnormal or normal) for
his/her follow up.

Table 1. Pulmonary Clinic Previsit Tests
Reason for Visit Radiology Tests Pulmonary Function Tests
Asthma Spirometry with bronchodilators if indicated,
lung volumes, diffusion capacity (DLCO) and
flow volume loops if not done within 6 months
Chronic obstructive
pulmonary disease
Spirometry with bronchodilators if indicated,
lung volumes, diffusion capacity (DLCO), flow
volume loops and arterial blood gases (ABGs) if
not done within 6 months
Clinic 6 minute walk test
Cough Spirometry- if not done within 6 months
Dyspnea Spirometry with bronchodilators if indicated,
lung volumes, diffusion capacity (DLCO), flow
volume loops – if not done within 6 months
Clinic 6 minute walk test
Interstitial lung disease,
Idiopathic Pulmonary
Fibrosis or sarcoidosis
Chest CT without IV
contrast (if not done
within previous year)

PFTs (lung volumes, spirometry with
bronchodilators if indicated, DLCO with ABG) if
not done within last 3 months.
6MW by respiratory therapy (if not done within
past 3 months).

Order Mode: Protocol/Policy, Cosign Required

References:
1. Busse, W., UW Health Clinical Practice Guideline – Diagnosis and Management of Asthma-
Adult/Pediatric – Inpatient/Ambulatory, July 2015.
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org

2. Cornwell, R. UW Health Clinical Practice Guideline – Chronic Obstructive Pulmonary Disease – Adult
– Ambulatory/Primary Care/Inpatient, January 2014.
3. Celli BR, Macnee W. Standards for the Diagnosis and Treatment of Patients with COPD: A Summary
of the ATS/ERS Position Paper. Eur Respir J. 2004; 23(6):932-46.
4. Parshall MB, Schwartzstein RM, Adams L, et al. An official American Thoracic Society statement:
update on the mechanisms, assessment and management of dyspnea. Am J Respir Crit Care Med.
2012;185(4):435.52.
5. Murray JF, Mason RJ, Boraddus VC et al. Murray and Nadel’s Textbook of Respiratory Medicine.
Saunders; 2010.
6. American Thoracic Society, ATS Statement: Guidelines for the Six Minute Walk Test, March 2002.
Accessed March 2016.
7. UW Health COPD guideline
8. Raghu G, Collard HR, Egan JJ, et al. An official ATS/ERS/JRS/ALAT statement: idiopathic pulmonary
fibrosis: evidence-based guidelines for diagnosis and management. Am J Respir Crit Care Med.
2011;183(6):788-824.

Collateral Documents/Tools:
1. Health Facts for You #5364: Pulmonary Function Tests, March 2015
2. Health Facts for You #4351: CT/CAT Scan, January 2014

Approved By:
UW Health Ambulatory Protocol Committee: March 2016
UW Health Clinical Knowledge Management Council: April 2016
UWHC Medical Board: May 2016
UW Health Chief Clinical Officer: May 2016

Effective Date: May 2016

Scheduled For Review: May 2019

Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org