4 Hidden Bottlenecks in Your Practice: How to Banish Them

Leigh Page


July 17, 2018

In This Article

More Tactics for Keeping on Schedule

Manage same-day appointments more strategically. Many patients ask for same-day appointments, which can force the practice to double-book appointments. "This can mean staying late to accommodate all of the patients who show up," Girgis says.

Girgis limits same-day appointments to patients who are really sick or in need of being seen. "Staying late is usually not an option, because many of us have kids to pick up after work," she says. "But we are open late on some evenings."

This may entail more careful screening when a patient phones for a same-day appointment. If you don't feel that the patient is critically ill, you can suggest an appointment the following day.

However, if the doctor is not going to screen calls for same-day appointments, the work should be done by registered nurses (RNs) or staff with even more clinical training, such as nurse practitioners, the American College of Physicians (ACP) advises. This work "cannot be delegated to unlicensed personnel such as office receptionists," the ACP states. Furthermore, "physicians should be accessible" to RNs doing the screening, and the RNs should use prepared texts to respond to callers' requests, the ACP advises. Physicians "should review nurses' scripts and protocols to determine whether they comply with acceptable standards and the physician's own medical philosophy," it adds.[2]

In addition to the ACP's advice, it's also a good idea that screeners have enough people skills to deal with patients whose requests for same-day appointments are denied. They need to reassure them that they will be able to wait without having any ill effects on their health. Some callers who insist on immediate care may be directed to an urgent care facility or an emergency department, if you are unable to see them that day.

Plan ahead. At the end of the day, physicians and staff should look at the schedule for the next day. Determine whether all necessary information is available in the patient's chart the day before. If you don't have all the information, try to get it before the appointment. This is a courtesy to the patient, who may have to take time off from work to come in for the appointment, and it's helpful to your schedule.

Determine patients' complaints before they meet with the physician. The goal is to know the patient's full list of complaints in advance. You can then determine which complaints need to be addressed in the current visit, and which can be addressed in a future visit.

If you don't know the full list, the patient may bring up a pressing complaint at the end of the visit, causing the visit to last longer than planned, says Marie Brown, MD, an internist and geriatrician at Rush University Medical Center and a physician lead for the American Medical Association's STEPS Forward program.

"Before patients are roomed, give them an opportunity to write down or share what they want to accomplish during that visit," Brown says. "Have them write down their three priorities for that visit." Some physicians give patients a piece of paper in the waiting room, on which to write their medical issues.


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