Easing patient backlog takes work and ingenuity
Here are some solutions to consider
It’s possible to eliminate a patient backlog, but it takes work, experts say.
"It takes everybody in the whole practice to work together and look at how they can treat the greatest number of patients most efficiently," says Tom Aug of Development Partners, a Cincinnati-based firm that specializes in patient satisfaction improvement for physician group practices.
Here are some suggestions for improving patient flow that Aug and other consultants have put into practice:
• Spread out your complicated appointments. For instance, don’t schedule back-to-back physicals or other procedures that take physicians a long time. In scheduling, medical offices need to set some time aside for extended office visits as well as the limited visits. (To learn how to tell how many of each kind of visit to expect, see box, p. 128.)
• Add examination rooms. Have enough examination rooms so people don’t have to wait long for an open spot. If the wait is going to be 20 minutes, have patients wait for 10 minutes in the waiting room and 10 minutes in the examination room, Hough suggests.
"Psychologically, it tells them they’re mov - ing along. It may require additional expense to have more examination rooms, but in terms of patient satisfaction, it goes a long way," he adds.
• Standardize the examination rooms. This enables each room to be used for flexible purposes and ensures that staff know where all items are located, suggests Mark Murray, MD, MPA, with Murray, Tantau and Associates, a health care consulting firm in Sacramento, CA, specializing in efficiency measures for physicians and hospitals.
• Consider hiring midlevel providers. Hough suggests that practices consider hiring a physician assistant or nurse practitioner to handle some of the routine patient care. "Some people say they can’t afford the additional expense, but I can demonstrate that within a reasonably busy physician practice, a nurse practitioner will earn her keep two- to threefold," Hough says.
• Track the waiting time for every patient, every day. Just tracking the waiting times so staff can see them may be a way to alleviate some hold-ups, Aug says.
He suggests having a space at the top of the encounter form that tracks the time the patient arrives, when the patient is called into the examination room, when the patient is seen by the physician, and when the patient checks out. "If the physician looks at the form before they see the patient, they can apologize for the delays and be aware that they are running behind," Aug adds. Sometimes, if other staff notice the delays, they’ll make an effort to improve the patient flow, he says.
• Consider extending your hours. Look at how your practice as a whole can be available to patients for more hours in the week, Aug suggests. "Physicians should look at their patient population to see how they can create a schedule that will benefit the [biggest] number of patients," he adds.
For instance, physicians in the office could rotate working late on certain days to see more patients, Aug suggests.
• Schedule additional appointments for patients with multiple problems. If a patient makes an appointment to take care of one problem and then mentions three or four other problems to the medical assistant, that visit can disrupt the entire day’s schedule, Aug points out. He suggests that the medical assistants ask the patients to make another appointment for their less-urgent complaints. "It doesn’t sound patient-friendly, but it can disrupt things for the rest of the patients if one person is allowed to monopolize the staff’s time."
He suggests that the medical assistant tell the patient: "These problems require a lot of time to deal with, and we’re on a tight schedule today. We can schedule another appointment so you can get the attention you need."
• Synchronize your systems. Take steps to make sure the patient, the provider, and the paperwork all start at the same time, Murray suggests.
• Reduce the need for unnecessary visits. "The key linkage to eliminating unnecessary visits is between the doctor and the patient. There are a lot of strategies you can put into place," Murray adds. Some suggestions include increased telephone triage and doing more with each visit to decrease the total number of visits.
• Work longer hours to catch up on your current backlogs. "This takes work. Basically, physicians have to work more for a short period of time to get the backlog eliminated," Murray says.
"Our mantra is, Do today’s work today.’ What we see in most organizations is that they’re doing last month’s work today," Murray adds.
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