How to trim patient wait times -- or make waiting easier

A column about keeping your practice in good health

By — Posted March 8, 2010.

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When patients arrive for an appointment, they frequently have to wait.

Sometimes, they wait a long time.

And if this situation is not addressed, they might leave and never come back, experts said.

"Patients will leave a practice if they feel that their time has been disrespected," said Stephen Albrecht, MD, a family physician and medical director of Olympia Family Medicine in Washington.

Experts say wait times do not have to be long to annoy patients and the way to solve a wait-time problem will be different for every practice. The initial challenge is to look at how patients move from the parking lot to the waiting room to the exam room and identify where the most common bottlenecks occur.

"The first step is analyzing what is going on," said David Belson, PhD, a professor of industrial engineering at the University of Southern California in Los Angeles who has worked with several health care systems on this issue. "You can start to see where the delays occur."

Answers will vary, but there are common themes.

The practice may not be scheduling patients appropriately. For example, patients known to have needs that take 20 minutes may be scheduled for 10-minute time slots.

Patients who are usually tardy might not be encouraged to be on time. Accommodating these late patients may delay those who are prompt.

And in expectation of some no-shows, patients may be double-booked, which experts say is a recipe for trouble if everyone scheduled actually arrive.

One common piece of advice from experts: Patients should be booked at shorter intervals. Booking one patient every five to 10 minutes most likely will run more smoothly than booking two or three every 15 minutes.

Experts also say it is important to consider when the office is really ready to receive patients. Some offices book the first appointment at the same time physicians and staff get there, and this guarantees the day will start off behind schedule.

"If the first appointment is at 8 o'clock and the staff shows up at 8 o'clock, how long will they be turning on the equipment and putting their coats away? These patients are ready for 8 o'clock, but those sessions don't start until 8:20," said Jayne Oliva, a principal with Croes-Oliva Group in Lexington, Mass.

Medical practice administrators also should look at how patients are checked in and moved into a room. Is there paperwork that could be sent to a patient to complete in advance of the visit? Once a patient is in a room, does the physician have everything he or she needs to provide the appropriate care without having to hunt?

"You want to make sure the visit is efficient, and the doctor is not exiting the room looking for things," Oliva said. "A physician should never have to leave the exam room for another piece of paper or a test."

Sometimes patients can make physicians run late because they bring a laundry list of complaints for a 10-minute time slot, but this, too, can be managed by informing patients in advance how much time they most likely will have with the physician based on the initial complaint.

"No patient knows how much time they are scheduled for because nobody ever tells them," said Meryl Luallin, a partner with SullivanLuallin Inc., a San Diego-based consulting firm.

Physicians also can spend a few minutes at the beginning of a visit setting an agenda based on their own and the patient's priorities. Patients then can be advised to make another appointment for less-pressing concerns that cannot be handled in the time set for the visit.

"Physicians should maintain control of the encounter," Luallin said. "Many times the patient will come in for one reason. Then, midway through, they bring up something else, and then at the end they say, 'By the way ...' That can be avoided at the outset by negotiating with the patient what can be covered in the allotted time. Patients like this because they know that the doctor will address the specific things that are most important to them."

If a patient does end up waiting a significant amount of time, which sometimes is unavoidable, practice consultants say any negative feelings can be mitigated by making the reception area more pleasant. Several services provide magazines at a discount or at no cost for doctors' waiting rooms. But make sure the magazines are not out of date. Some practices also have started providing wireless Internet access.

American Medical Association policy encourages medical settings to provide diverse educational tools promoting preventive health measures.

When patients have been sitting long past their appointment times, an apology and an explanation also can go a long way to appease them. Front-office staff can keep patients up to date and let them know how long they may be waiting, but physicians also can handle this task.

For example, Dr. Albrecht, who is also president-elect of the Washington Academy of Family Physicians, offers wireless Internet in his waiting room and tries to minimize patients' waiting times. Sometimes, however, medical emergencies make keeping on schedule impossible. So he will pop his head into the waiting room to acknowledge his patients, tell them what is going on and give them a chance to reschedule.

"On the days I'm 45 minutes late, it makes me just as crazy as it is making them. We make sure that the patients are aware of what is going on when they are checking in," he said. "Then patients can do what's best for themselves."

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