Transforming Health Care Scheduling and Access Getting to Now (2015) / Chapter Skim
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2 Issues in Access, Scheduling, and Wait Time
2 Issues in Access, Scheduling, and Wait Time
Pages 17-32
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From page 17... ...
Modified block scheduling assigns a smaller number of patients to smaller segments of time throughout the day, such as hourly. Individual scheduling, the most commonly used scheduling technique in the country, occurs when a single patient is scheduled for a specific point in time, with the timing of the appointments determined according to the supply of care providers (NAE/ IOM, 2005)
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From page 18... ...
for ambulatory care, defined as the average length of time in days between when a patient requests an appointment and the third next available appointment; boundary approaches, such as the 4-hour wait time target for emergency departments used in England and Australia (Hughes, 2010; IHI, 2014a,b; Jones and Schimanski, 2010; Weber et al., 2012) ; and the "office visit cycle time," defined as the time between a patient's arrival and departure times at a medical office, which can be used to separate productive time from waiting time.
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From page 19... ...
Individual scheduling is the most commonly used scheduling technique in the United States, implemented through patient-by-patient scheduling for a specific point in time on a specific day, according to care provider availability in the care setting. Modified block scheduling assigns a smaller number of patients to smaller seg ments of time throughout the day, such as hourly.
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From page 20... ...
This section provides an overview of the scheduling practices typically employed in various health care settings. It also discusses some of the issues that lead to delays and increased wait times.
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From page 21... ...
Any scheduling system used in specialty care must not only accommodate a clear definition of a care team, variable caseloads, and clinical times, it must also accommodate providers with substantially different experience levels. Specialty Care: Providing Mental Health Services With the implementation of the Affordable Care Act and the expansion of Medicaid, an increasing number of people are gaining access to treatment for mental health and addiction services because of the increased use of public and private insurance coverage.
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From page 22... ...
. Besides contributing to increased levels of patient frustration and anxiety, prolonged waiting times and protracted lengths of stay can also increase the proportion of patients who leave emergency departments without being seen by a physician (Johnson et al., 2009; Monzon et al., 2005)
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This can lead to a situation in which there are vacant beds that could be occupied by patients who may be kept waiting somewhere else, including hallways or the emergency department. Discharge The discharge planning and placement processes require coordination and communication among personnel from different departments.
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From page 24... ...
At this time, the best practices for access to inpatient rehabilitation hospitals and skilled nursing facilities remain largely undocumented or validated and will require further development and evaluation. FACTORS IN SCHEDULING DELAYS AND VARIABILITY Some of the causes of prolonged wait times are inefficiencies in operation, in care coordination, and in health care organizational culture that result in flow disruption, the underuse of resources, and an imbalance between the demand of patients to be seen and the supply of providers, facilities, and alternative strategies to care for them at any given time (Mazzocato et al., 2010; Young and McClean, 2008)
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From page 25... ...
Daily patient "demand" covers not only the actual visits of patients but also all contacts from patients reporting problems that day -- each query requiring contacts from health care system resources to accommodate properly. Supply entails resources that include labor, equipment, and any required physical environment for safe delivery.
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From page 26... ...
Health care providers focus on providing care with autonomy and on receiving payment for that care. Providers have incentives to deliver higher paid services that can be supplied at low costs.
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From page 27... ...
Small changes include such strategies as divesting from physicians tasks and responsibilities that can be performed by other members of the care team, while greater transformations through the enhanced role of nurses may include using nurses to facilitate care coordination, implement and manage informatics systems, act as health coaches, and serve as primary care providers themselves (IOM, 2011)
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From page 28... ...
For example, urgent appointments placed through priority-based scheduling practices often address only one need per visit, which limits the opportunity for the care provider to meet multiple needs of the patient in a single visit. In addition, patients diverted to other settings for urgent care often want to follow up with their primary doctor later on, expanding a need for one visit into a need for multiple visits, and patients requiring visits deemed to be routine or less urgent can experience increased wait times (Murray and Berwick, 2003)
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From page 29... ...
The Department of Defense Military Health System has designated a standard of a 30-minute drive time for primary care appointments and a 60-minute drive time for specialty care appointments (DoD, 2014)
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From page 30... ...
For example, the Military Health System and the California State Department of Managed Health Care devel ped benchmarks for access and included the following (DoD, 2014) : o • 30-minute drive time for primary care • Specialty care appointments within 4 weeks • Routine appointments within 1 week • Urgent mental health care by a physician or non-physician clinician within 48 hours • Non-urgent appointments with specialist physicians within 15 busi ness days
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From page 31... ...
ISSUES IN ACCESS, SCHEDULING, AND WAIT TIMES 31 • Non-urgent appointments with a non-physician clinician within 10 business days • Urgent care appointments generally not to exceed 24 hours • Emergency room access available 24 hours per day, 7 days per week • 60-minute drive time for specialty care • Office wait times not to exceed 30 minutes unless emergency care is being rendered to another patient Benchmarks such as these have served as useful reference points at the practice level in various places. Yet, because they have not been validated for national use, they are of limited applicability.
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