For efficient patient flow, use all the modalities of care wisely

You’ve had a busy morning and remember that you saw one of your regular patients come into the office earlier, but later in the day you realize that you never treated him. When you ask a front-desk staff member what happened, the answer is, “Oh, he left because he waited 15 minutes.” Later, before you leave for lunch, you ask the staff member, “What happened to the new patient scheduled at 10 am?” The response: “She finally left because she waited too long.” You begin to realize that you need to control patient flow in the office. To help you avoid these situations or to help you improve your patient flow, I have outlined some easy patient-flow solutions.

You Control the Flow
Whether your office is slow or busy, patient flow is important. It will be controlled by either you and your staff, or the patients and the staff. By controlling the flow yourself, you will be able to see more patients more efficiently, and ultimately give them the best care you can. One approach to improve the flow of the office is to incorporate all the modalities of care available and use them wisely. Many of us have ice, heat, intersegmental traction, and therapy balls, but don’t use them to our timely advantage. Another approach is to have a trained staff that understands patient flow and communicates with you.

Patient flow is not just about keeping tables open and ready for the next patient. It’s about recognizing who is in the office and what you and your staff can do to keep patients moving within the office. If the reception room is full, many patients will get discouraged thinking they will have to wait a long time before they are seen. If they sit in a room or on a table waiting for their doctor and nothing is happening, they can feel ignored. To serve patients well, and serve more patients, keep them moving.

In my office, I use a flexion/distraction table, an intersegmental traction table, heat, ice, and therapy balls. I practice in Washington and therefore cannot use modalities such as ultrasound or current. But with these simple above modalities, I can move about 45 patients in and out of my office in a day. Sometimes I see 20 of them between 4 pm and 6:30 pm. Let’s look at what you have in the office to help your patient flow.

Heat
Moist heat is a very simple tool to help your patient flow. You can buy a small hydroculator for about $270 with heat packs included. Many patients we treat have chronic problems in which simple heat will help improve blood flow, increase circulation, and help you administer trigger-point therapy. It will help some of your more apprehensive patients relax so they can receive the adjustment better. Heat also feels good, especially if you treat geriatric patients. They love moist heat.

Many doctors will say, “Well, that doesn’t help my patient flow; it hurts patient flow because administering heat to a patient will tie up an adjusting table.” How many cervical spines do you treat? If the answer is a lot, heat/ice can be applied to the patient while he is sitting in the waiting room enjoying a magazine, not taking up any space. This is also a great time for the patient who thought you only treated low-back pain to see you caring for a neck problem. That’s great patient education without marketing.

It’s very helpful to teach your staff which patients should be given heat (or ice), how to apply it, and for how long and where. Demonstrate to the employees how to properly and safely administer the heat, and after a while, they will do it for you. In the morning, go over the schedule with the staff and write small notes next to the patient’s name—for example, “H” for heat or “I” for ice. I also use “IST” for intersegmental traction. You also want your staff to ask the patients if there have been any new injuries or changes in their condition since their last visit, because you never want to apply heat to an acute condition. As a bonus, many insurance companies pay for heat therapy, so it also pays off financially.

Ice
For a little investment, you can go to a local department store or home-improvement superstore and purchase a small upright freezer. Purchase your ice packs from medical-supply catalogs, and you are ready to go. Keep a lot of ice packs in the freezer, because patients who feel better after ice treatment will ask, “Where can I buy one of those ice packs?”

This is another way to treat a patient while he sits in the waiting room. After you have taken x-rays of a new patient, or after you examine the existing acute patient with severe low-back pain, have him sit in the waiting room with an ice pack behind his low back. This is also a great place to demonstrate low-back seat supports. Again, you are not taking up a room or table, and you are creating an environment where patients will talk about their problems. In the meantime, you can go treat two or three other patients while that patient sits on ice for 10 minutes.

Therapy Balls
Therapy balls are another great form of treatment that will help with patient flow. When a patient goes back to a treatment room, teach him how to sit on a therapy ball. Patients do not like to sit in the treatment room, but by doing therapy-ball work, they are now having therapy, not sitting. In this case, you will most likely be using a treatment room, but therapy balls can be used in your reception room as well. Remember, reception rooms that look too full can cause stress for patients on a tight schedule. If you have a room available, obviously use it. This is important, because a lot of patients who drop in without an appointment may see a lot of patients in the waiting room and turn around and walk out thinking they’ll have to wait too long. Encourage drop-ins, but be sure you’re able to accommodate them. They are patients that need you and value chiropractic.

Making sure that each room you have is being used efficiently will keep your waiting room clearer and encourage patients to stay. Another bonus is that many people want to purchase the therapy balls.

Walking Around After Adjustment
This is an easy solution to the problem of not enough chairs and no rooms available. After you adjust a patient’s lumbar spine or the SI joints, have the patient walk around for a few minutes before you recheck the treated area. This will enhance the adjustment you just administered and give you the opportunity to see a couple of patients while the low-back patient is walking around. After he walks around for a few minutes in the waiting room (by the way, this tends to trigger more conversation among patients wanting to know why they are not sitting, which means more patient education), recheck his spine to make sure you accomplished your goal of increasing joint mobility.

Placement of Tables
I have visited many offices in which an IST table is in a separate room all by itself. This is a waste of space. Most offices have an x-ray room that has a little extra space. If this is your case, put the IST table in the x-ray room. You will very rarely leave the patient on the table for more than 10 minutes, so it will not hold up x-rays. It also does not take more than 10 minutes to shoot x-rays, so you will rarely compete with each other for the room.

Breaking Up the First Office Visit
I am not an advocate of “no treatment on the first visit.” This method is an injustice to the patient. What I mean by breaking up the first office visit is that a patient’s first visit should have five basic components:
•consultation;
•exam;
•x-rays;
•diagnosis (not report of findings); and
•treatment.

On the first visit as you enter the room, tell the patient that the visit will be broken down into a few segments. Next, describe how you will consult with the patient about his problem, say you will step out before you examine him, and, if necessary, send him to the x-ray room.

Using this procedure, or being up-front with the patient about why you are going in and out of the exam room and then being able to break up the visit, will enable you to go in and out of the room between each of the segments listed above and treat different patients while you are still processing a new patient. Remember, at this point, your staff should be working with you, applying heat or ice to the other patients in the office.

Communication
It’s a good idea to encourage your staff to keep you informed as to what is going on in the office as you are in the exam room. I sit and stand in a specific spot in the exam room so my staff can get my attention.

I give them the opportunity to peek in the exam room and let me know what is going on in the waiting room. This way, if a patient drops in while I am with a new patient or an acute existing patient, or in a meeting with a patient, and the staff needs my help, I can instruct them what to do right away.

Communication with your patients is also a major part of your patient flow. If your patient brings up something that really needs to be discussed, and he springs this on you after you are done adjusting him, you need to be able to communicate with that patient. For example, you could say, “Mr Jones, I hear you stating that you started to have pain and numbness down your arm. At this point, I have only treated your low back. I will have to take a couple extra minutes to talk to you about this new problem. Let me step out for a minute and treat a couple of patients, and I will come back so we can chat and I can then examine this new problem.” With this, you have acknowledged your patient’s statement, you have let him know that you are concerned, and you have communicated to him that you will return soon to further speak with him.

So what’s the bottom line in patient flow? Keep the patients moving. It’s that simple. No matter where you are in your office, the better the staff communicates with you, the better you will be able to control patient flow and your day at the office. CP

Greg Beasley, DC, practices in Everett, Wash. Contact him at beasleys1@comcast.net.