Improving the patient experience in Miles City, Montana

Abbey Ingvalson, physician assistant, is always on the move in the General Surgery Clinic, located within Holy Rosary Hospital in Miles City, Montana.?

In a rural area with limited resources, Abbey and team (two medical assistants) are turning the typical general surgery model on its head, using creativity and innovation to provide the best patient experience possible.

It is not always easy to recruit specialized medical providers to rural locations. This facility came up with a creative staffing model, hiring general surgeons who travel from out of state every two weeks, providing consistent coverage on a rotating schedule.

As the only full-time surgery provider in the clinic who lives locally, Abbey provides continuity for the team and patients. She sets up the majority of surgeries, handles the surgery workups, and initial patient consultations. The patient then meets with the surgeon right before the surgery. Typically, PAs do more post-operative and follow-up care, but not at this clinic.?

“Patients have consistency and someone who can be with them through the entire process, from beginning to end,” she said. “If a patient comes into the ED and needs surgery, and the doctor has to leave the next day, I’ll be there with the patient after the surgery. Even though the surgeons are rotating, the patients still have consistency, and it creates a team feeling. I absolutely love it.”

Abbey came to the clinic as a student, during her surgical rotations. At that time, it was only the rotating surgeons seeing all the patents, both pre- and post-op; completing pre-surgery workups; and doing both emergency and elective surgeries.?

Often the surgeon would have to cancel appointments the following day if they had done emergency surgery the night before. That model did not create a positive or consistent experience for patients.??

It was during her surgical rotation?Abbey made the suggestion to hire a PA to ensure consistency for patients, processes, and procedures. Abbey joined the team after completing school and has been there?for two years now.??

“This could easily become a typical model in rural areas, it’s very sustainable,” she said. “I can do a lot more of the background work in the clinic, work that doesn’t require physician level involvement, and it works really well. I believe this model should be utilized more.”??

The community has benefitted significantly from this model:?

• More available clinic time means increased access for timelier treatment??
• Test results communicated faster – patients had to wait for the surgeon to come?back in town before receiving test results?
• More timely prescription processing?
• Reduction in canceling and rescheduling of patients?
• Cleared the backlog of patients that once existed?

In addition, the clinic has started providing dermatological services – skin screenings and skin cancer management. Early detection and treatment services are a huge asset to this community with limited resources.?

“There's always such a difficulty finding providers who want to work in a rural setting,” she said. “Being?here in this small town has been such an incredible quality of life change for not only me, but my family. I would strongly encourage anybody to consider rural medicine if they have the opportunity to do so.”?

Limited resources couldn’t stop this small but mighty clinic from improving the patient experience. With a little creativity and passion to make things better Abbey and team have taken general surgery patient care to the next level.