Introduction

Appointment scheduling is the process that determines which patients the provider sees, the dates and times of appointments, and how much time is allotted to each patient based on the complaint and the provider’s availability. Time management involves the realization that unforeseen interruptions and delays always occur and must be handled appropriately. In addition, the medical assistant must assign the appropriate appointment time length for the complaint along with ensuring that the appointments are scheduled so that there are minimal gaps in the schedule. Most healthcare providers find that efficient appointment scheduling is one of the most important factors in the success of the practice. Scheduling can be done in a number of ways, and each facility must find the way that suits it best.

As a Medical Assistant, you will need to know all aspects of schedule management. This includes how to create and utilize a paper appointment book or an electronic scheduler in the practice management system.

The appointment book

Developing a schedule that meets the needs of both the providers and the patients is key to keeping the office running smoothly and efficiently. The scheduling team, along with the provider, should come up with scheduling parameters to both meet the needs of the patient population and keep the providers’ preferences and habits in mind.

Time is of great value for everyone involved- The practitioner, the patient, and the office staff. Scheduling appointments in an organized fashion shows respect for everyone’s time and creates an efficient patient flow. If the schedule is changed for any reason, the medical assistant must update the appointment book or scheduler and make sure that everyone involved is aware of the change. A well managed appointment book, regardless of whether it is an actual book or an electronic format within a computer system, is key to patient continuity of care and presents the office in a positive, professional manner, ultimately keeping all parties involved on task and on time.

Although most patients understand that they may have to wait in the reception area before they are seen by their provider, few patients are willing to wait more than 20 minutes. Offices that routinely have long waiting times can find themselves with dissatisfied patients, which can lead to other problems such as losing patients.

Applying the appointment matrix

Setting up the appointment matrix involves blocking out the times when the provider is not available to see patients, such as lunch time, hospital rounds, conferences, and vacation. In a paper-based appointment book the matrix is usually established for 6 months at a time. In a computerized system the matrix can be set up indefinitely.

Procedural steps for creating a matrix

1. Using the calendar, determine when the office is not open (e.g., holidays, weekends, evenings). If using the appointment book and a black pen, draw an X through the times the office is not open. If using the scheduling software, block the times the office is not open. Blocking the closed times of the office helps prevent patients from being scheduled when the office is closed.
2. Identify the times each provider is not available. If using the appointment book, write in the providers’ names on each column and then draw an X through their unavailable times. If using the scheduling software, select each provider and block the times the provider is unavailable. Many providers do rounds in the hospital or long-term care facilities and cannot see patients in the clinic during those times. Providers also attend meetings and conferences during the workday. These events, along with vacations and lunch times, should be blocked on their schedules.
3. Using the office procedure manual or providers’ preferences, determine when each provider performs certain types of examinations. In the appointment book, indicate these examinations either by writing the examination time or by highlighting the examination times. Follow the office’s procedure on indicating these examination times in the appointment book. When using scheduling software, set up the times for the examinations or use the highlighting feature if available. Some providers perform a variety of examinations. It can be more time efficient to have the same types of examinations on the same day. For instance, a provider in a women’s health department may perform both gynecologic and prenatal examinations. The provider may prefer to set aside certain days to do prenatal examinations and other days to do gynecologic examinations.
4. Using the office procedure manual or the list of providers’ preferences and availability, identify other times to block on the scheduling matrix. Some providers require catch-up times and these time slots are blocked. Some medical facilities save appointment times for same-day appointments. When saving time blocks for same-day appointments, make sure to use pencil so it can be erased and the patient’s information entered on the day of the appointment. For the scheduling software, block those times when patients cannot be booked and indicate the times for the same-day appointments. Allowing appointment times to be saved for same-day appointments provides the opportunity for the provider to see a patient who needs to get in immediately and prevents the patient from being turned away or double-booked.

Appointment scheduling

Before establishing the appointment matrix, decide the length of the shortest office visit type. This visit type would usually be for a follow-up or recheck appointment for an established patient. Other specific appointment types should now be determined. General categories for appointment types are: follow-up or recheck, wellness examination, complete physical examination, ur­gent visit, new patient visit, and comprehensive visit. Each category has a specific amount of time assigned to it; for example, a follow-up or recheck appointment could be 15 to 20 minutes and a comprehensive visit could be 30 to 40 minutes. The providers and scheduling team should work together to come up with these time periods to ensure that the office runs smoothly and efficiently.

If it is decided that a complete physical examination should be scheduled for 30 minutes, yet the provider routinely spends 45 minutes with the patient for a complete physical, then the scheduling guidelines need to be adjusted. Well-planned scheduling and adherence to that schedule allow the provider to do more than run in and out of examination rooms with little time for the patient to talk with the provider. There will be a bit of trial and error when developing the priorities for the appointment schedule.

Some providers need prompting to end the patient visit and move to the next patient. If there is a medical assistant in the examination room, he or she can help the provider remain on schedule by letting the provider know that the end of the appointment time is near. They may work out some type of signal, such as a hand gesture or phrase. A pager may be used when the medical assistant is not in room with the provider. When the provider’s pager vibrates he or she will know that it is time to wind things up with that patient. The clinical medical assistant and the administrative medical assistant must work together to keep the healthcare facility running smoothly and efficiently.

Another factor to keep in mind when scheduling appointments is the availability of facilities needed for the particular appointment type. Getting a patient into the office at a time when no facilities are available for the services needed is pointless. For example, suppose that a healthcare facility with two providers has only one room that can be used for minor surgery. Do not schedule two patients requiring minor surgery for the same time interval, even if both doctors could be available. If the healthcare facility has only one electrocardiograph, do not book two electrocardiograms (ECGs) at the same time. As the medical assistant gains proficiency in scheduling, it becomes easier to pair patient needs with the available facilities according to the provider’s preference. Major equipment frequently used or a certain room with such equipment may need its own scheduling column in the appointment book or software system.