Increasing office efficiency decreases waiting room time

More doctors are looking for ways to shorten the amount of time patients spend waiting to be seen.

By Cheryl Jackson, amednews staff. Oct. 7, 2002.

Beth Deutch, MD, gave a lot of thought to wait time before opening HerSpace Breast Imaging Associates, a fee-for-service practice for breast imaging in West Long Branch, N.J., last summer. The diagnostic radiologist put in a waterfall with alcove seating. She gave it a living room feel. She wanted a calming, welcoming atmosphere. And she wanted patients to spend as little time there as possible.

"I think there is the feeling that their time is less important than the physician's time and the staff's time," Dr. Deutch said. As a timesaving measure, HerSpace Breast Imaging Associates will offer forms online so that patients can download them and have them filled out before they arrive at the office.

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"The industry is becoming more and more aware of waiting as a problem," said Charles M. Kilo, MD, MPH, an internist and infectious disease specialist with the Greenfield Health System in Portland, Ore. "The current system was really set up around physicians' needs. It's disrespectful. People are busy."

Recently, health plans and employers have taken steps to make customer satisfaction a bigger factor in how they pay for the care of patients, which can influence how many patients a physician sees from particular plans.

But any lengthening in wait times is something physicians lay at the doorstep of managed care, saying its restrictions have slowed up the process of caring for patients, while their low pay requires doctors to see a greater volume of patients to maintain income levels. "The fact is that physicians are needing to see many more patients a day than they used to in order to maintain income and keep the business viable," Dr. Deutch said.

Long office waits are a symptom of overall systematic problems, she said.

A third of patient appointments booked 3 months in advance get rescheduled.

Doctors can increase efficiency by scheduling patients for visits differently, Dr. Kilo said, and moving toward a system that allows people to come in the day of their call.

Physicians should avoid routinely scheduling appointments for patients months in advance, because closer to the appointment times, patients will call and make changes, tying up staff. About one-third of appointments booked three months in advance get rescheduled, he said.

"The darn phone in the practice is ringing off the hook" with patients rescheduling appointments, he said.

Don't be so quick to have a patient come into the office when the case can be handled over the telephone or through e-mail, Dr. Kilo advises doctors. "We should dramatically decrease the number of patients we book," he said. "Every time a body has to move through the office, it's a lot of work."

Changing work flow also could result in keeping patients waiting less.

Dr. Kilo suggests completing all of the work around one patient before moving onto the next. Doctors typically do all of the charting for patients in one batch at the end of the day. But that practice often leaves physicians with something "not representative of what actually happened," he said.

A practice should take 15 minutes at the beginning of each day to prepare for patients before they arrive, he said. Standardizing the exam room also cuts down on time needed to find tools and information in each room, Dr. Kilo added.