How Best to Handle Walk-in Patients

September 21, 2012
J. Scott Litton, Jr, MD

Physicians in clinical practice have the distinct honor and privilege of being able to effectively care for our patients. Our patients have placed their healthcare in our hands, and as such, we owe it to them to provide the best and most efficient care we can possibly provide. In order to do this, physicians must manage their schedules efficiently so that our time spent with the patient is maximized and their wait times kept to a minimum. Our time is valuable however the time that our patients take off from work, away from their family, etc., is just as valuable to them as well.

In my practice I have two nurse practitioners that have a regular patient panel. Not only do these nurse practitioners consult me and seek input regarding their patients' care, but these nurse practitioners are also able to see my patients when they call in or walk in for same-day appointments. The nurse practitioners' schedules are organized to have blocks of open time so that add-ons can be effectively cared for. However, there are times when patients come to the office and request the same-day services from the physician. How can we best accommodate these requests while efficiently caring for those patients that have previously scheduled appointments?

My schedule is blocked off in 15-minute intervals. I purposely do not over-schedule or over-book my appointments so that I have time available to accommodate walk-ins. Most patients that call in with acute illnesses such as URIs or UTIs are fine to see the nurse practitioners and are very satisfied with the care that is provided. My staff does encourage the use of nurse practitioners for same day call-ins as I am able to walk over and assist the NPs as needed. Very frequently I will walk in and provide an injection, an opinion, or otherwise assist the NPs with caring for our patients. This process has worked well for several years and the convenience has resulted in very high patient satisfaction scores.

However, there are times when the patient requests the undivided attention from the physician. It is for instances like this that we utilize the gaps in my schedule for such walk-ins. I am able, on average, to accommodate as many as four to five walk-ins per day in my schedule.

Many of the patients that request my services for walk-in appointments are elderly patients that I have cared for over many years. One such patient today came in with a new complaint of heartburn and also noted that her previously prescribed acid-lowering medication was not providing the symptom relief she wanted. After a careful history and physical, it was evident that she was eating more fast foods and such foods were causing her symptoms. I was able to change her medication and provide a bit of constructive criticism regarding her food choices. She left the office very satisfied and her family member that accompanied her echoed her satisfaction.

Not only was I able to care for her on the same day, but I was able to take advantage of the open slot that was created by a no-show appointment during the same time period. Another patient I cared for earlier this week had just lost her husband to an acute illness. This patient was having increased difficulty dealing with the loss of her spouse and she was very grateful for the fact that I shortened my lunch block to provide care for her. Such cases do lengthen our already very hectic days, but such care is needed and is expected from our patients.

Same-day call-in appointments can be difficult to accommodate in practices that are already overbooked. It is very important for us to remember that we must treat our patients as if they were members of our own family. We must ask ourselves, if my relative were ill today would I expect that their physician should accommodate them?

Leaving open slots in the schedule to provide for open access can not only allow you to capture every possible encounter during the day, but it also provides for tremendous patient satisfaction. It prevents your patient from potentially checking in to an already crowded ER and also decreases the probability that your patient might elect to leave you for another physician with available appointment slots. It can be a challenging service to provide, but anticipating the needs of our patients before they come to the office can provide for positive word of mouth recommendations that can be more valuable than any advertising method currently available.

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