Best Practice Guide: Patient Flow

In 2017 we surveyed participants in the 2016-2017 CHC Learning Program about best practices for optimizing patient flow.  Here are ten ideas for optimizing patient flow art the front desk:

• 1. Front Desk Conductor. We created a new position at the front to help with patient flow, the conductor. The conductor greets all visitors, vendors and/or clients of the health center finding out what they need and helps guide them appropriately. This helps to alleviate congestion at the front, gives potential clients information on services, the registration process etc. and provides back up to the front desk staff.
• 2. Designated ‘Call Center.‘ We designated one of our front desk staff personnel to act as a “call center”. This has freed the other front staff members to address patients as they come to the window and not worry about answering the telephone.
• 3. Patient Portal. Our patient portal permits patients update registration and other business forms which expedites their visit at the front desk.
• 4. Personal Documents. Having patients prepared for their visit helps to optimize patient flow at the front desk. Patients are informed prior to their visit of the necessary documents they should bring to their appointments (insurance cards, photo id, etc.) and to arrive 15 minutes early. Patients applying or needing to renew the sliding fee scale are also advised to bring in the proper proof of household income. New patients can also download the registration form from our website which helps speed the registration process once they are in the office.
• 5. Pre-Visit Forms. We mail new patient info prior to the visit and we also have new patient forms on the website. We ask that patients return before the first appointment when possible. We plan to implement kiosk for patients to update information that should drop into our EHR immediately so clinical has updated info when they bring the patient back.
• 6. Follow-Up Appointment Scheduling. We eliminated the need for patients to line up at the front desk post visit to reschedule their follow up appointments. Many times, if there was a wait or line, patients historically just left the facility without scheduling a follow up.
• 7. Front Desk Manual. Created a Front Desk Manual so front desk at all sites have the same process and procedure information. In the process of training a Care Coordinator who will register all new patients before they are seen. Will remove all incoming calls from the front desk.
• 8. Out of Work/School Notes. Front desk prints the “out of work/school notes ” and gives it to patient/parent at end of visit. They also print out the visit summary and give it to the patient/parent at end of visit.
• 9. Streamlined Forms. We updated our new patient forms and shorted them as much as possible.
• 10. Check-In Messaging. We message the clinical staff when a patient is checked in and forms are completed to be sure that they know a patient is ready to be taken back.

In the same 2017 survey we also asked participants to share best practices for optimizing patient flow at other points in the process.  Here are ten ideas provided by survey respondents.

• 1. Tracking Patients through the Visit. So that everyone is able to track patients when they enter the building, we came up with a visit status that indicates where each patient is in the process. This prevents the provider skipping patients thinking they didn’t show up for appointments.
• 2. Height/Weight/BP Station. We rearranged our dental clinic so that the height/weight/BP station is in an area before the patient enters the clinic. This has kept our clinical hallway from getting congested.
• 3. Dental Scheduling. For our dental program, we identify simple versus complex procedures so that two complex procedures are not concurrently scheduled.
• 4. Portal. Web-enabled patients are able to request appointments via the portal. *
• 5. Chronic Disease Day. Incorporated Chronic Disease Day (monthly) to allow Providers to spend additional time with patients diagnosed with chronic illnesses such as Diabetes, Hypertension, Asthma, etc.
• 5. Standing Orders. Standing orders for various chronic diseases – nurses can carry out screening tests, vaccinations, etc. before the medical provider sees the patient
• 6. Kiosk. We will be implementing a kiosk.
• 7. Flag System. We have a flag system on each exam room door that alerts the provider when a patient is ready and waiting.
• 8. Clinical Staff Training in Scheduling. We trained our clinical staff on how to schedule appointments for their providers. Currently, as part of the visit discharge process, clinical staff print and review the visit summary then schedule a follow up visit when the patient feels they can most likely have transportation / or what best works with their schedule. The patients can just leave the facility at that point – no need to stand in another line….
• 9. Patient Flow Analysis. We have examined our patient flow from the front desk back to the rooming of patients, seeing the provider and are working to make sure no patient is left unattended until the visit is over.
• 10. Medication Review. The nurse/MA reviews/updates all of the patients medications prior to provider seeing the patient so that the med list reflects what patient is currently taking.

The AMA STEPS Forward project provides best practice modules on multiple topics related to patient flow,  including the following.

• Adopting a Patient Pre-Registration Process
• Expanded Rooming and Discharge Protocols
• Implementing a Point of Care Registry
• Optimizing Space in Medical Practices
• Pre-Visit Lab Testing
• Pre-Visit Planning
• Starting LEAN Health Care
• Synchronized Prescription Renewal
• Team Documentation

Additional articles with Practice Tips:

• Reducing Incoming Phone Call Volume (Medtronic)
• Tips to Manage Incoming Calls at Your Medical Practice (Physicians Practice)

Community Health Solutions delivered a webinar on optimizing patient flow in April of 2017.  Below are the slides and a tool for using design thinking to solve process problems.

• Patient Flow Webinar Slides
• Tool for Design Thinking
• Seven Questions to Ask before Adopting a Best Practice