Open-Access Appointment Scheduling in Family Practice
Open-Access Appointment Scheduling in Family Practice
Background: Inadequate access to their primary care physician remains a major reason for patient dissatisfaction in ambulatory care. The concept of open-access appointment scheduling has been found to accommodate patients' urgent health care needs while providing continuous, routine care. We describe the development of a demand prediction grid for future appointments, compare it with one developed by Kaiser Permanente, and compare the predictions with actual appointments made and held in our clinic.
Methods: Using adjusted 1999 appointments based on historical data for the Scott & White Killeen Clinic (>75,000 annual appointments; 13 family physicians), we computed appointment predictions for calendar year 2000 by day of the week and by month of the year. We then compared our predictions with those of Kaiser and actual appointments for the first half of 2000.
Results: Our data and the Kaiser data agreed on the day of week, but they were different for the summer and winter months. Overall, actual appointments made and held at our clinic for January through June 2000 were within 6% of the predictions. Appointments for January and February were 18% and 4% more than the predictions, respectively, while appointments for March were 3% less than the predictions. Appointments for April through June were 3% to 7% more than the predictions. Few daily variations were observed between actual appointments and predictions.
Conclusions: We conclude that the Kaiser data might be tempered by a different climate, underscoring the need for each practice to develop its own demand prediction grid. That our actual appointments were 6% more than predicted overall but fluctuated month by month reemphasizes the need for continuous monitoring of the adjustment factor for prediction.
Physicians who practice in ambulatory primary care are currently facing tremendous challenges in meeting the high demand for instant access to health care. This demand is clearly reflected in both ambulatory care standards and managed care standards. Inadequate access to their primary care physician remains a major reason for patients' dissatisfaction in ambulatory primary care. In the United States, the average waiting period for a routine medical appointment is at least 3 weeks. The concept of open-access appointment scheduling has been recognized as one way to accommodate patients' urgent health care needs while providing continuous, routine care as demanded in primary care, enriching service, using better available physician time, and improving the use of other provider resources.
Open access is the practice of scheduling patient appointments so that appointment slots are deliberately left vacant for daily access on demand. These appointment slots can then be used by patients in the physicians' panels at the clinic. The aim of this concept is to provide patients, if they wish, an appointment with the provider of their choice on the day that they call. The basis of the open-access concept is the assumption that demand for same-day appointments can be predicted in any practice, and this demand prediction can be used to determine actual patient appointments by day of the week and by month of the year. In general, an open-access appointment-scheduling system should result in improved patient access to health care in a timely fashion.
Using the open-access appointment-scheduling concept requires aggressive management to predict accurately patient volume and the required staffing patterns. A prediction grid for forecasting same-day appointment demand is critical for implementation. Unfortunately, however, many providers who want to start open access do not have the demand prediction grid, particularly in the absence of a sophisticated electronic medical records system. Developing a prediction grid can be challenging. Although it is possible to depend on a prediction grid developed in a practice other than one's own, it is important to consider certain differences that can exist between practices. For example, many practices might be tempted to use a prediction grid developed by Kaiser Permanente (personal communication, Sue Herriott, RN, MA, Carle Clinic, Champaign, Ill, 1 and 2 October 1997), which, to our knowledge, is the only one available.
In this article, we describe the development of a patient appointment demand prediction grid for one of the 18 regional family practice clinics of the Scott & White Health Care System. We then compare this grid with one developed by Kaiser by day of the week and by month of the year, as well as with actual patient appointments made and held at our clinic during a 6-month period.
Background: Inadequate access to their primary care physician remains a major reason for patient dissatisfaction in ambulatory care. The concept of open-access appointment scheduling has been found to accommodate patients' urgent health care needs while providing continuous, routine care. We describe the development of a demand prediction grid for future appointments, compare it with one developed by Kaiser Permanente, and compare the predictions with actual appointments made and held in our clinic.
Methods: Using adjusted 1999 appointments based on historical data for the Scott & White Killeen Clinic (>75,000 annual appointments; 13 family physicians), we computed appointment predictions for calendar year 2000 by day of the week and by month of the year. We then compared our predictions with those of Kaiser and actual appointments for the first half of 2000.
Results: Our data and the Kaiser data agreed on the day of week, but they were different for the summer and winter months. Overall, actual appointments made and held at our clinic for January through June 2000 were within 6% of the predictions. Appointments for January and February were 18% and 4% more than the predictions, respectively, while appointments for March were 3% less than the predictions. Appointments for April through June were 3% to 7% more than the predictions. Few daily variations were observed between actual appointments and predictions.
Conclusions: We conclude that the Kaiser data might be tempered by a different climate, underscoring the need for each practice to develop its own demand prediction grid. That our actual appointments were 6% more than predicted overall but fluctuated month by month reemphasizes the need for continuous monitoring of the adjustment factor for prediction.
Physicians who practice in ambulatory primary care are currently facing tremendous challenges in meeting the high demand for instant access to health care. This demand is clearly reflected in both ambulatory care standards and managed care standards. Inadequate access to their primary care physician remains a major reason for patients' dissatisfaction in ambulatory primary care. In the United States, the average waiting period for a routine medical appointment is at least 3 weeks. The concept of open-access appointment scheduling has been recognized as one way to accommodate patients' urgent health care needs while providing continuous, routine care as demanded in primary care, enriching service, using better available physician time, and improving the use of other provider resources.
Open access is the practice of scheduling patient appointments so that appointment slots are deliberately left vacant for daily access on demand. These appointment slots can then be used by patients in the physicians' panels at the clinic. The aim of this concept is to provide patients, if they wish, an appointment with the provider of their choice on the day that they call. The basis of the open-access concept is the assumption that demand for same-day appointments can be predicted in any practice, and this demand prediction can be used to determine actual patient appointments by day of the week and by month of the year. In general, an open-access appointment-scheduling system should result in improved patient access to health care in a timely fashion.
Using the open-access appointment-scheduling concept requires aggressive management to predict accurately patient volume and the required staffing patterns. A prediction grid for forecasting same-day appointment demand is critical for implementation. Unfortunately, however, many providers who want to start open access do not have the demand prediction grid, particularly in the absence of a sophisticated electronic medical records system. Developing a prediction grid can be challenging. Although it is possible to depend on a prediction grid developed in a practice other than one's own, it is important to consider certain differences that can exist between practices. For example, many practices might be tempted to use a prediction grid developed by Kaiser Permanente (personal communication, Sue Herriott, RN, MA, Carle Clinic, Champaign, Ill, 1 and 2 October 1997), which, to our knowledge, is the only one available.
In this article, we describe the development of a patient appointment demand prediction grid for one of the 18 regional family practice clinics of the Scott & White Health Care System. We then compare this grid with one developed by Kaiser by day of the week and by month of the year, as well as with actual patient appointments made and held at our clinic during a 6-month period.
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