Monday, February 25, 2008

Phone Screening & Open Access (Same Day) Surgery

Let me preface this blog by saying that I believe our clinic runs efficiently. We are a specialty clinic where patients are referred from generalists, seen for consultation then booked for surgery if needed. After doing a process flow map from the patients’ perspective we realized there was a group of patients that could have their consultation and surgery on the same day.

Having a consultation and procedure for surgery completed in one appointment saves the patient two trips to the clinic (including two sets on phone calls, in-clinic waiting, etc….), and the clinic from having to organize two appointments. Of course, a certain percentage of these people will arrive expecting to have the surgical procedure completed and it will not be required, thus wasting a surgical appointment.

The corollary is that when surgery is completed with more than one appointment there is the potential that the patient will not follow through (thus wasting a consultation appointment), that the appointment will be forgotten, that there will be an administrative error causing missed or forgotten appointments or another type of error that introduces wasted time. Multiple appointments, however, ensures that all surgical appointments booked are truly required.

We decided to put the theory to the test that having strict phone screening of patients that were referred for open access appointments (same day surgery) would decrease workload. The list was very simple – the patient is not on wafarin (a blood thinner), they don’t need pre-op antibiotics, they can have it done under local anaesthetic and a few others. If the patient met the criteria they were booked for surgery and consultation the same day. We did this for 10months then compared those patients to a group from the corresponding 10 months in the previous year (prior to having the list in place).

What were the results? In the study period 2627 patients were reviewed and compared to 2187 patients in the ‘control’ period (for the purists out there we also studied the demographics and compared them using t-tests and chi-square analysis; they were the same). An additional 3% of patients (100) had their surgery done the same day (p=0.000003 for the statisticians) which was a very significant difference. Now 3% may not seem like a lot but it saved us a total of 25 hours worth of work on the surgeons part and days of waiting on the patients part. It also opened up 25 hours worth of time for other patients, thereby decreasing our wait time for everyone.

Did we find any surprises – yes. As I’ve mentioned in other posts, 5.5% of patients did not follow through in both groups. One would assume that as more patients had same day surgery the non-follow through group would diminish but we didn’t see it. I don’t think this is a statistical glitch, I believe that there is a group of patients that are reluctant to follow-through and no matter how you book them it won’t happen.

The take home message is that working to condense appointments can save the clinic and your clients’ time. The effect is exponential for the administrative staff because every additional appointment adds work before and after especially when appointments are missed or moved. Have strict written criteria and reinforce it rigorously.

Amendment to this story as of May 23, 2008: We have had to add the biphosphonate group of drugs to the list of those that can't be booked for open access because they need a 3 month drug holiday.


Anonymous said...

Very intersting. I was wondering about the differences in the total number of patients seen between the two periods. Were you able to see more patients as a result of an increase in capacity due to an increase in same-day bookings, or was there simply more capacity for other reasons?

Ian Furst said...

You can't really tell from this data sample because it's only one part of our total patient pool but there was more capacity and we were receiving a greater number of patients from areas that previously did not send patients to us. This type of referral is common to someone that is starting to send patients to the practice.

Buffy said...

Can you survey any part of the drop out to discover why they are falling out? Some of them may be falling out due to fear - which may not change if it was same day.

Ian Furst said...

Tough to survey (pt's that don't follow-up are notorious for not returning surveys). It's anecdotal but there is a group of patients that won't take it the tooth out unless it's hurting. I assume percentage wouldn't change over the period (e.g. roughly 5% didn't have a sore tooth, were told it needed to come out but didn't because no pain).