OPEN ACCESS OR ADVANCED ACCESS SCHEDULINGAuthors, M.D., M.P.A. Show
AffiliationsMark Murray & Associates, LLC Primary care services form the core of the ambulatory health care system, are in high demand, and are characterized by the most prolonged waits. Access to robust primary care also lies at the heart of effective delivery system reforms, such as with the formation of accountable care organizations (ACOs) and patient-centered medical homes. Current attempts to triage health care appointments based on anticipated patient acuity are unreliable, costly, and operationally difficult. Preferable is the presumption of same-day response to requests, with patient preference serving as the key determinant of the actual timing and nature of care or provision of alternative arrangements. Presented below is one successful method to provide same- or next-day appointments. Although presented in sequence, many of the steps will overlap in practice. Active involvement of patients and their families is an integral part of the design, implementation, and evaluation of this plan. Actions in Phase One: Past and Prospective Data Collection
Actions in Phase Two: Balancing Demand and Capacity
Actions in Phase Three: Addressing Backlog
Actions in Phase Four: Using the New Scheduling Template
REENGINEERING FLOW THROUGH THE PRIMARY CARE OFFICEAuthorsEugene Litvak, Ph.D. AffiliationsInstitute for Healthcare Optimization The balance of providing timely appointments to patients who need and want them while maintaining a smoothly running practice can be a challenge. Transition is often best accomplished in phases and involves the active participation of all those affected by the change, including patients and families. The following represents one three-phased approach. Phase one focuses on balancing resources and flow of patients with time-sensitive medical complaints with those with elective or scheduled appointments. The main goals of this phase are to improve patient access for those with time-sensitive needs (same-day access and walk-ins) and to decrease the operational chaos that results from competing demands for appointments. The second phase turns attention to the challenge of smoothing elective or scheduled patient flow, such as appointments for yearly physicals, immunizations, or blood pressure checks. The main goals of this phase are to maintain continuity with a specific provider to maximize the quality of care, decrease competition between scheduled and unscheduled appointments, and to enhance office throughput of patients. The third phase aims to optimize capacity in the office to improve quality, safety, and throughput. Using alternative ways of addressing patient concerns, alternative settings of care, and alternative providers when needed creates the opportunity to correct the size of the appointment type and number to better match capacity with demand. Actions in Phase I
Actions in Phase II
Actions in Phase III
REENGINEERING FLOW THROUGH THE ACUTE CARE DELIVERY SYSTEMAuthorsEugene Litvak, Ph.D. AffiliationsInstitute for Healthcare Optimization Coordinating the function of the operating room and inpatient units is one of the most challenging tasks in health system reengineering and is perhaps best tackled in stages. Key to the successful design, implementation, and evaluation of these plans is the active participation of patients and families. The following represents one three-phase approach. Phase one focuses on balancing resources and flow of time-sensitive emergent/urgent with elective/scheduled admissions (mostly surgical). The main goals of this phase are to improve patient access and decrease daily operational chaos that results from competing demands. The second phase turns attention to the challenge of smoothing elective/scheduled patient flow (e.g., surgical, catheterization lab, or radiology procedure) to inpatient units. The main goals of this phase are to improve quality and safety of care on corresponding units, decrease competition between scheduled and unscheduled flow on inpatient units, and to enhance elective surgical or medical throughput (or both) depending on the hospital's priorities. The third phase aims to correctly size inpatient units to improve quality, safety, and throughput to alleviate medical ward bottlenecks that can feed back to the operating room. This phase addresses artificial variability in admissions, discharges, and transfers and improves throughput in selected medicine units by ensuring appropriate patient placement and improving the timeliness of admissions, discharges, and transfers out. In doing so, it also creates the opportunity to correctly size medical wards to better match capacity with demand. Actions in Phase I
Expected Outcomes in Phase I
Actions in Phase II
Expected Outcomes in Phase II
Actions in Phase III
Expected Outcomes in Phase III
FRAMEWORK FOR ACTIVE PATIENT INVOLVEMENT IN ACCESS AND SCHEDULINGAuthorsJames B. Conway, M.S. AffiliationsHarvard School of Public Health Core Principles of Patient- and Family-Centered Care
Tenets of a Patient- and Family-Centered Access and Scheduling System
Hypothetical Model of Application1.Questions arise around health and health care: —Patient, family, and staff seek counsel when new questions arise or new information is needed. —The system for moving forward is understood by all. 2.Collaborative processes are implemented to move forward and to get answers: —Focus first and foremost on meeting the needs of the patient: providing the right care, at the right place and the right time, every time. —Use a wide range of asynchronous approaches. —Ensure access to the right people to match needs. —Engage patient and family members in full partnership, with questions prompted, invited, answered, and understood by all. —Make a consultant immediately available. 3.Scheduling test, treatment, consult, and so on: Ensure an efficient processes: one person, one call, one time. —Offer a wide range of approaches, such as scheduling online, in person, or over the phone, with navigation and other assistance, such as language and access support, when needed. —Determine what works best for the patient and family. —Seek out and address any special needs and requirements. —Prepare in advance, and provide fact sheets. 4.In the interval: focus on questions and preparations: —Ensure immediate access to a person 24/7. —Solicit and answer questions. —Distribute and follow through on preparations. —Provide directions. —Provide preappointment notifications. 5.Once the appointment is held: —Update administrative needs and medication. —Ensure that all parties are on time (patient, family, and staff), or are informed if not. —Deliver care in appropriate and respectful setting. —All parties prepare questions, listen, and respond. —Patient choses who is with them. —Document in electronic health record (EHR) system. —Next visit follow-up before leaving. 6.Follow-up actions taken: —Results and follow-up actions are communicated to patient and family members in real time in person, via end-of-visit note, and in patient portal. —Results are communicated to care team in real time. —Patient and family members are engaged in any revision to care plan. 7.Ongoing care is provided with care team (patient, family, and all staff). Patient and Family Collaboration in Design and Continuous Improvement of Access and Scheduling Systems
TABLE A-1Application of Mindfulness to Patient- and Family- (P&F-) Centered Access and Scheduling. REFERENCES
Which of the following medical record filing systems best provides confidentiality of patient information?Chapter 10 hw. Which of the following should be included in the patient's medical history?In general, a medical history includes an inquiry into the patient's medical history, past surgical history, family medical history, social history, allergies, and medications the patient is taking or may have recently stopped taking.
What kind of system assigns consecutive numbers to patients as they visit the clinic?The straight filing system is also referred to as the consecutive filing system. Patient records are filed in strict chronological order according to patient number from lowest to highest. It is a common practice that medical record numbers contain six digits.
Why is it advantageous to schedule patient appointments?Proper patient scheduling allows front-desk staff to avoid spending all of their time and energy on patient management. This allows staff members to focus on other tasks, such as handling patients who are already in the office while simultaneously reducing the number of calls that the practice receives.
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