Transforming Health Care Scheduling and Access Getting to Now (2015) / Chapter Skim
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Appendix A: Background Papers
Appendix A: Background Papers
Pages 107-122
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Appendix A Background Papers 107
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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.
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The panel sizes for each provider may be different. • Determine the practice visit rate using the practice average as well as the individual visit rates.
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• When scheduling return appointments, it is essential to look at the en tire schedule to avoid overbooking of any particular day in the future. The goal is to spread out demand from patients who choose a day other than today with prescheduled return visits in order to preserve enough time for expected daily demand.
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• Use a care team workload analysis for the entire practice to drive un necessary work away from providers. • Demand reduction strategies can help balance an unbalanced equation or can serve to open capacity for new patients entering the practice when supply and demand are balanced.
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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 • Separate patients into homogenous groups (i.e., same-day access or walk-ins versus scheduled flows, new patients versus return patients)
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-- Develop office strategy and resources for answering phone calls to minimize the loss of potential patients. Actions in Phase III • Once scheduled demand is smoothed, determine the number of appoint ment slots needed for same-day, walk-ins, and prescheduled patients.
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• Prospectively collect data based on the above criteria to accurately determine demand. • Review office capacity scenarios using data, and make necessary changes to better match capacity to demand.
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The third phase aims to correctly size inpatient units to improve quality, safety, and throughput to alle viate 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.
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Expected Outcomes in Phase II • Increased throughput in smoothed inpatient unit. • Increased placement of patients in the optimal units with decreased postanesthesia care unit boarding and interunit transfers.
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• Quality improvement with decreased readmissions, decreased use of rapid response teams, decreased rate of hospital-acquired infections, and increased patient safety.
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-- get information and services that meet my needs, not just a visit, I by using a wide range of asynchronous approaches -- smart phone apps, e-visits, my home or workplace, and online scheduling. -- have access to the right people to match my needs, not just to I physicians, but to community health workers, lay care coordina tors, interdisciplinary teams, and pharmacists.
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Hypothetical Model of Application 1. Questions arise around health and health care: -- Patient, family, and staff seek counsel when new questions arise or new information is needed.
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7. Ongoing care is provided with care team (patient, family, and all staff)
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Sensitivity to Paying attention to what's Staff seeks to understand from P&F operations happening on the front-line the gap between system designs on paper versus actual delivered. P&F are probed for their experience as they moved over time and across the continuum.
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