How many times have the patients in your retina clinic said, “I’m only here for an injection, what’s taking so long?” or “We do the same thing every time. I don’t understand why it has to take so long.” If this sounds familiar to you, then rest assured, you are not alone.
Managing a high volume of patients who receive anti-VEGF intravitreal injections in a timely manner can be a real challenge in a retina clinic. Since these patients often need treatment on a frequently recurring basis, the sheer volume of patients can often complicate scheduling. For many retina practices that are already used to having overbooked clinics, this increase in patients can be encumbering to your workflow. Knowing which of your established patients will take the most time while in office can help you to create a schedule template that can reduce their overall time spent waiting. And even better, it could also help streamline your clinic flow in the process.
In this article, we will share some strategies on how we assembled an express lane for our established patients, along with some additional tips and tricks.
Establish express visits
Establish “Express” visits by determining which of your injection patients require extensive imaging or testing from your patients who will not need an examination or further procedures. While most patients will still need thorough disease monitoring and testing at every appointment, some visits may not be as time intensive. If a patient does not require an examination or testing the day of their injection, then the visit is relatively speedy. In our private practice, these quick visits may only happen once every few months for each patient, but being able to pinpoint these straightforward visits allows you to schedule them at the most opportune time where it will most benefit your workflow.
Look at your operational needs
Pinpoint your operational needs by assessing your current workflow to ascertain where a boost in speed might be most beneficial. Consider factors such as office space, capacity, number of clinic lanes, availability of equipment, time that your bottlenecks typically start to happen, and average face time with physicians per patient. This will help you to determine how many of these patients you can accommodate in your schedule and where. Keep in mind that the ideal schedule template is not the same across the board and will look different for every location, clinic and physician.
Take a lean approach
Trim the fat by identifying factors that occur throughout a patient’s visit that are redundant or not essential. For instance, dilation or additional testing may be considered a waste for some visits, so consider factors such as, how long ago the most recent fundus photos or examination were performed. By assessing the patient’s history and their disease progression, your physician can decide whether any elements are appropriate to be eliminated from the work-up process. For example, a patient who comes in for bilateral injections, who just had an examination and imaging done last week and is now returning for fellow-eye treatment may not need to have the full work up again. This lean approach can be tailored on a case by case basis.
We started this process as a trial. While this was something far from what we would normally do, we met frequently, discussed possible concerns and watched metrics closely to ensure that our patients were still getting the care they needed.
The non-negotiables for our trial
Clear communication is key when initiating your trial
Educate your staff from your scheduling team all the way to your clinic scribes. Make sure that you have created a keyword or way to flag the visit so that staff can easily recognize the express ap-pointments and what it means. Since these quick visits only happen on a visit by visit basis, we found it best in our practice to communicate when the next appointment is going to be an express by listing it in the follow up notes. We knew that no matter what we chose as the identifier, it need-ed to be somewhere where any staff could easily locate it.
Extend the communication throughout your practice. Ensure that all staff have an understanding of what the desired outcome is and how you plan to achieve it. Even those who you may not think would be directly affected may have some feedback or questions of their own.
Train your technicians
As always, training the technicians is another must. When a patient is being seen for an express appointment, your screeners and work-up techs should still be asking the patient about vision changes or new symptoms and know when they need to diverge from the trial protocol and pivot to a routine appointment. While time and efficiency are important, patient care is always the top priority.
Establish trackable metrics
Begin collecting current data before you begin your trial to evaluate your current state. Once you begin your trial, track your daily metrics. Compare results and use them to recognize when you need to deviate from or tweak your trial processes to make sure that they are having the desired impact.
We started our trial in August 2018 and were able to run metrics on how long the average injection patient spent in-office from check-in to check-out. On average, an established injection patient was spending approximately 2 hours and 32 minutes per appointment. By October of 2018, our numbers showed that our Express patients were averaging as little as 48 minutes in office! Needless to say, the trial was a success.
What helped us achieve this improvement was meetings, communication, metrics, training, documentation and physician buy-in.
Taking a leap of faith to implement changes in your clinic can be daunting, but with careful consideration and planning, it can lead to improved efficiency and overall happiness for your patients. A small change today can have a significant impact on your future. OP
