Managing Patient Flow: How to Keep it Moving

Bottlenecks happen in many practices despite our best efforts at scheduling prowess. In my practice, it usually happens when a few patients come late and a few come in early. It gets worse when the one in between takes much more than the allotted scheduled time.

When these happen, it can be quite stressful. Patients get anxious and start to complain about the all too well-known wait. As tempers simmer, the urge to push onwards intensifies and it is easy to miss things when this pressure builds. We get burned out trying our best for patients who are dissatisfied that they waited too long. In the meantime, you can't remember the last time you ate or went to the bathroom.

How can we optimize patient flow?

- Eliminate no shows. To stay on schedule, we need to know the patients on the schedule. When gaps suddenly pop up, we may be able to catch up on other tasks such as phone calls and prescription refills, but we often get caught up in these tasks and enter the next visit late. Some doctors charge for no shows. In my practice, we have worked hard to eliminate no shows. Billing for them would be more work than it was worth.

- Fixing persistent lateness. Some doctors have the 15-minute rule: if you arrive more than 15 minutes late, you need to reschedule. We all know things happen: the traffic is heavy, the weather is bad, the appointment took longer than was planned. That is why I see patients whenever they come. However, if it happens persistently, that is time to lay down the ground rules. A family used to come persistently late as the last appointment of the day and everyone had to wait the 20-30 minutes for them to come. After the third time, we simply told them they were too late and made them reschedule. It did not happen again.

- Teamwork is key. Everyone needs to be aware of the schedule and recognize when it is lagging behind. My nurse usually adds vital signs to the EHR before I see the patient but when the lag starts, it waits until the patient seen. Little time stop gaps can help get the train back on track.

- Fit patients in when you can. If a patient is taking a long time, see another patient in between. For example, I may have the nurse draw the blood work while I go see another patient.

- Find the bottlenecks. Find out where the bottlenecks arise and get rid of them. If it is one employee who is incredibly slow, retraining may be in order.

- Scheduling is very important. We sometimes double-book like most other practices. But only certain types of patient visits can be double-booked: acute visits, quick follow-ups. If we know a procedure will take time, we should allow for that on the schedule. When we are in too much of a hurry, complications happen.

- Ending unwanted interruptions. Salespeople stop in all the time and they all just want "five minutes of the doctor's time." If I gave them all five minutes, I would not have time to see any patients. Anyone who wants to speak with me about a product or service needs to schedule an appointment. I set aside two time slots a week for these appointments. I do not add extra time slots just because someone asks. If you want to pitch your wares to me, that is when I am available.

While the public thinks doctors make them wait on purpose, this simply is untrue. We are busy and getting busier every day. However, we need to try to reduce these waits as much as we can out of respect to our patients. Things happen that get us off track, but the track should be laid down carefully before the train starts its journey.