Different Approaches to Handling Same-Day Visits

February 25, 2011

For many busy primary-care physicians, the daily task of managing scheduled appointments with adding call-ins or walk-in visits can be daunting.

It is Thursday morning. Your schedule looks to be full with very little room for call in visits. The day before the start of the weekend is generally the busiest with many patients seeking care before the upcoming two days off. For many busy primary-care physicians, the daily task of managing scheduled appointments with adding call-ins or walk-in visits can be daunting.

There are several ways of handling acute care visits. First of all, the patients that walk in for care generally do so because of an acute illness or other medical problem that they feel needs attention right away. These patients do not want to hear that the doctor cannot see them. This is the most common reason that patients will change to another medical practice. Those patients who ask for same-day care must be greeted politely and their chief complaint appropriately triaged by a nurse so that their care can be managed most efficiently.

Some physicians choose to leave slots in their schedule allowing for same-day visits. This is known as open access. However, this scheduling system does not always work well for every practice. Medical practices like mine that have a high population of elderly patients with multiple medical problems generally have schedules that are booked solid for several days in advance. Another option for addressing acute care visits is to simply overbook the schedule. While this can guarantee that patients that present for care can be treated, it can carry with it dissatisfaction by other patients with previously scheduled appointments by way of increased wait times. Unless overbooking is the norm and patients are accustomed to waiting for extended times to see the physician, this model generally is not the most efficient method.

What our practice chooses to do is to utilize nurse practitioners to care for the walk-in acute care visits. As long as this model carries with it the appropriate supervision by an attending physician, it can work quite well. Patients that come in for same-day service are treated and the plan is presented by the midlevel provider and approved by the physician. If a patient has a complicated problem, the physician is easily able to manage the treatment, or in our practice's case, possibly completely assume the care from the midlevel provider. When patients present to our office with an acute problem (for example, chest pain) that will require a trip to our hospital's ER, those patients are quickly triaged and the physician assists with their care by contacting the ER and notifying them of the problem in advance. Even though this process can delay your schedule, a simple explanation to the patients waiting for you is generally well-received and appreciated. This can be very reassuring to your patients.

The task of addressing acute care visits in a medical practice that already has a tight schedule will continue to be an ongoing challenge. While one method of providing additional access might not fit for all practices, the process of addressing the usual number of acute care visits by season can allow practices to examine their work flow processes and possibly increase access by adding an additional midlevel provider during peak times or even have designated days with extended hours for care available. There is no single method that can solve this problem, however when patients present for care on a day when access is most certainly going to be a problem, informing patients that long wait times are possible and reassuring them that the practice will strive to accommodate their needs is generally well accepted by patients and they will appreciate your efforts.