Monday, May 12, 2008

Block Booking for Procedural Patients

For ENT, opthomology, oral surgery and other specialists whose practice are dependent on scheduling procedures here is a suggestion for block booking. I've previously posted on why block booking controls health care and surgical wait times and how it improves satisfaction. For more detailed infomration click here. Our practice is largely determined by the load of 3 or 4 different types of procedures. The patients are seen once prior to the procedure for 15-30minutes. The procedure is then scheduled for 15-60 minutes and 10-15% of them require a 15minute post-operative visit.

The first part of the equation is the easiest to solve – how many procedures should be booked in a single day. This may be dependent on wait time, resources or populational need. Or you may simply want to maximize one type of procedure

Determining the Number of Procedures

First specifically define the procedure type. To calculate the wait time for that procedure, count the number of people in the schedule going forward and dived by the number completed per day. Fifty people in the schedule divided by 5 per day equals a 10 day wait. You can adjust the number of procedures per day based on this.

Population need is difficult to calculate but we’ve found it to be a surprisingly static figure. Calculate the number of procedures completed per 10,000 people per year. For instance the need for dental implants in the US is about 40/10,000 per year. From this you can calculate the number of procedures per year assuming you’re the only specialist in a community. On a smaller scale, calculate the number of procedures completed per year for a community, the size of the community and the clinics “market share” of patients seen.

Finally, when there is greater need than resources and you need to maximize the number of procedures in a day its’ a bit of a balancing act. Start with the procedures using all of the available time then back-track the number of consultations and other visits that would be required (see below for details on this). Finally start backing down on the number of procedures until the total time used with consults, procedures and other visits fills the total time available.

Determining the Number of Consultations:

I have friends that book 1 day/ afternoon for consultations and the rest for procedures but there’s not a lot of logic to it. Either they see too few consults and the days open up or too many and the wait list becomes excessively long. I’d suggest an agreeable wait time be determined between the consult and the procedure. Depending on how involved the procedure is 2-3 weeks will fill the day and give people enough time to arrange for time off work. Next, look back at you’re schedule to determine the number of people that actually follow-through with recommended treatment. This could vary greatly depending on the procedure needed but I’ve seen it range from 55-95%. Let’s assume that 85% of people follow though from the consultation. If you can complete 5 procedures per day then you need to see 5 divided by 0.85 = 5.8 per day (29 per 5 days).


Finally calculate how many people return for follow-up and include that in the calculations as well in the same way consultation time was determined. For this example let’s assume that 12% of patients need a follow-up or 25 x 0.12 = 3 follow-up appointments

Putting it All Together

Last but not least add up all the time required and see if it still fits in the schedule.

Procedures: 60 min
Consultation: 15 min
Follow Up: 15 min

Based on 25 procedures per week
Procedures: 25 x 60 = 1500 min
Consultations 29 x 15min = 435 min
Follow-Up 3 x 15 min = 45 min

So the total time requirement is 1500 + 435 + 45 minutes =1980 min = 33 hours per week

When you do these calculations for multiple procedures you can add or steal time from one procedure or another to balance the amount of wait from the time of referral to the time of procedure.

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