1. Chapter 13
Patient Scheduling

2. Tailoring the Scheduling System
Customize system to accommodate practice
Primary goals
Smooth flow of patients with minimal amount of waiting time
Flexibility to accommodate acutely ill, STAT appointments, work-ins, cancellations, no-shows

3. Scheduling Styles May be done manually or electronically
HIPAA sign in compliant
Sign-in sheet most efficient means of checking in patients

4. Patient Sign-In Sheet
[FIGURE 13-1]

5. Scheduling Styles Open hours
Patients seen throughout particular time frame (examples: 9:00 am to 11:00 am or 1:00 pm to 3:00 pm)
Patients seen on first-come, first-served basis
Maintain steady flow of patients
Sign-in sheet

6. Scheduling Styles Double booking
Two or more patients given particular appointment time
Limited to practice that can attend to more than one patient at a time
Patients should not have to continually wait for staff to attend them

7. Scheduling Styles Clustering
Patients with similar problems booked consecutively
Common for obstetricians and pediatricians

8. Scheduling Styles Wave scheduling
Patients scheduled in first half hour of each hour
Requires personnel who are able to prioritize patient problems precisely when establishing appointments

9. Scheduling Styles Modified wave scheduling
Two or three patients scheduled at beginning of each hour, followed by single appointments
Variation assesses major and minor problems
Good screening will determine success of this method

10. Scheduling Styles Stream scheduling Best known and most widely used
Each patient assigned specific time
Establish realistic time guidelines for particular types of appointments

11. Scheduling Styles Practice-based scheduling
Customized systems to fit needs of medical office
Practice determines schedules
Many variations of scheduling styles
Appointment scheduling can be accomplished online

12. Analyzing Patient Flow
Patient flow analysis
Clear picture of patient flow
Whether personnel being used efficiently
Will help estimate number of patients to schedule
Sets realistic time frames for procedures

13. Analyzing Patient Flow
Patient flow analysis
Electronic scheduling systems can automatically provide detail to analyze effectiveness of patient scheduling
May allow more minutes for follow-up visits or build in slack time

14. Analyzing Patient Flow
Waiting time
Explain reason for delay
Give patients estimate of how long delay will be
Never ignore delay
Attempt to keep patients comfortable

15. Analyzing Patient Flow
Waiting time
Attempt to contact patients before they leave home to reschedule appointments if delay anticipated
Provide options if delay will be half hour or longer
Act professionally

16. Legal Issues Appointment schedules are legal documents
Computerized systems provide permanent record of patients seen
Appointment book or daily appointment sheet is permanent record
Accurately and consistently document all aspects of patient care

17. Interpersonal Skills
MAs convey a great deal to patients through attitude and actions as well as empathy
Patient should always be made to feel worthy of attention
[FIGURE 13-5]

18. Guidelines for Scheduling Appointments
Variables
Urgency of need of appointment
Whether appointment has referral from another provider
Recording methods for new and for established patients

19. Guidelines for Scheduling Appointments
Variables
Implementation of check-in, cancellation, rescheduling policies
Use of reminder systems
Accommodating visits from medical supply and pharmaceutical company representatives
Group scheduling may be appropriate

20. Guidelines for Scheduling Appointments
Screening calls
Assess urgent calls before scheduling them
Ask appropriate questions
If questioning indicates medical emergency, follow policy for having patient seen
Do your best to address the situation

21. Guidelines for Scheduling Appointments
Referral appointments
Give special consideration and schedule appointment as soon as possible
Obtain records and information from referring provider’s office
Determine urgency and appropriateness of appointment

22. Guidelines for Scheduling Appointments
Recording information
Patients may be sensitive about giving information
Keep information as simple as possible; obtain only essential information
Basic items should be obtained from new patient
Clinics with computerized scheduling and billing will require additional items

23. Guidelines for Scheduling Appointments
Recording information
List of information to obtain from established patient
If possible, provide choice of appointment times; confirm appointment
Scheduling convenient time for patient may be difficult
Evening or Saturday morning appointments helpful

24. Guidelines for Scheduling Appointments
Appointment matrix
Gives current, accurate record of appointment times available
Identifies provider’s schedules, vacations, holidays, hospital rounds, meetings
(See Procedure 13-1: Establishing the Appointment Matrix in a Paper System)

25. Guidelines for Scheduling Appointments
Electronic scheduling
Computer searches database for available appointment times
Confirms time and date with patient
Enter patient data to automatically schedule appointment
(See Procedure 13-2: Establishing the Appointment Matrix Using Medical Office Simulation Software)

26. Guidelines for Scheduling Appointments
Patient check-in
Records of patient appointments serve legal purpose
Establish procedure for checking in appointments
More than one method can be used to check in patients
Alerts staff patient arrived and available to be seen
Can be done manually or electronically
(See Procedure 13-5: Checking in Patients in a Paper System)
(See Procedure 13-6: Checking in Patients Using Medical Office Simulation Software (MOSS))

27. Guidelines for Scheduling Appointments
Patient cancellation and appointment changes
Indicate no-shows with red X or distinctive mark
Indicate cancellations with single red line
Note no-shows and cancellations on patients’ charts
(See Procedure 13-7: Cancelling and Rescheduling Procedures Using Paper Scheduling)

28. Guidelines for Scheduling Appointments
Patient cancellation and appointment changes
General rule: after three no-shows or cancellations in a row, provider will review records
Patient may not be committed to treatment
Providers may decide to terminate services by sending certified letter to patient

29. Guidelines for Scheduling Appointments
Patient cancellation and appointment changes
Computer cancellations
Be certain program maintains list of canceled appointments including patient name, date, time
Necessary for legal purposes
(See Procedure 13-8: Cancelling a Patient Appointment Using MOSS)

30. Guidelines for Scheduling Appointments
Reminder systems
Result in greater rate of fulfilled appointments
Methods
Appointment cards
Telephone call
Test message
Mail
(See Patient Education box)

31. Guidelines for Scheduling Appointments
Scheduling pharmaceutical representatives
Some medical clinics refuse to see pharmaceutical representatives
However, they can provide valuable service to providers and staff
May set aside specific time during week or standard appointment once a month
Determine time allotted

32. Scheduling Software and Materials
Proper tools will enable patient scheduling to smoothly function
Materials needed for scheduling should be customized

33. Scheduling Software and Materials
Appointment schedule
Essential system to any medical practice
Physical arrangement of scheduler must be determined
Appointment sheet necessary for legal risk management and quality management
Enables staff members to see total day’s patient flow
Can be transferred to handheld computer device

34. Scheduling Software and Materials
Computer scheduling software
May schedule resources, equipment, examination rooms, specialty staff as well as patients and providers
Select next available appointment
Can be component of practice management facility

35. Scheduling Software and Materials
Computer scheduling software
Online systems can handle prescription refill requests, patient–provider messages, laboratory results
Electronic scheduling has become the “entry” to field of computerized medical information

36. Inpatient and Outpatient Admissions Procedures
Appointments for outpatient or inpatient procedures most often made while patient is in facility
Appointments might include:
Endoscopy exams
Specialized radiology procedures
Computerized tomography (CT) scans and magnetic resonance imaging (MRI) procedures
(See Procedure 13-9: Rescheduling a Patient Appointment Using MOSS)

37. Inpatient and Outpatient Admissions Procedures
If patient prefers to make arrangements for procedure, following information necessary:
Name, address, telephone number of patient
Name of provider ordering procedure
Name of procedure and preoperative diagnosis
Name of patient’s insurance, ID number, Social Security number

38. Inpatient and Outpatient Admissions Procedures
When MA schedules procedure:
Make certain patient knows correct date and time
How to get to place where examination performed
Inform how and when he or she will receive test results
If someone is needed to provide transportation home

39. Inpatient and Outpatient Admissions Procedures
Scheduling inpatient admissions to hospital:
Provider may want patient in hospital quickly
Provide pertinent patient and insurance information
In primary care, MA will do scheduling
When surgery scheduled, MA must sometimes coordinate several entities
Be sensitive to patient’s needs at this time