Office Environment

10 Ways We Manage Patient Flow in Our Office

By David I. Geffen, OD, FAAO

Avoid patient bottlenecks, in which office visits are delayed or stalled, and enhance the patient experience.

We like to create a fluid, convenient patient experience in our shared OD-MD practice. That requires a patient flow process that keeps patients moving efficiently without sacrificing quality of care.

Our practice schedules comprehensive exams every 30 minutes, and one or two short visits, like a contact lens follow-up, in between. The pre-test time is 14-16 minutes for every patient, which allows me about 12-14 minutes with the patient to go over the results. In between I can see one or two patients there for short visits, and see a dilated patient. We pride ourselves on not making our patients wait more than 10 minutes, and meet this goal most of the time.

The wait time is 10 minutes, or less, between each step in the exam process, meaning 10 minutes from reception check-in to pre-test, and 10 minutes between pre-test and when the doctor enters the exam room.

Identify Common Culprits
Patients who show up late
. When the 8 a.m. patient shows up at 8:15, it can set us back for most of the morning.

Pre-testing. With limited office space, our pre-test room is small with equipment taking up every possible space. If the patient is a slow responder, or very talkative, it is sometimes difficult for the technicians to get the patient through all the tests we require. Some people become difficult to perform photography, or an OCT, on, and then the doctor may be waiting while the rest of the schedule backs up.

Challenging patients. Some patients become more difficult than anticipated. This includes someone who may have severe retinal damage, and may need in-depth explanations, or a call to a retinal specialist. Another time-consuming visit is a new patient who turns out to have keratoconus and needs extra time to be fitted with contacts.

Emergency patient. Sometimes, such as in the case of eye injury, we need to see someone immediately, and this can cause problems with the rest of the day’s schedule.

Implement Solutions
Track time
. The most important strategy we have implemented is to make sure our pre-test technicians know how much time they are in the room, and if time is running out, they have certain tests to skip, which I can perform quicker in the exam lane.

Silently alert doctor. We have the YAK system in our Nextech practice management software, which enables staff to send me a message silently by text without disturbing the patient in the chair to let me know what is happening in other parts of the office. Too many times we get into personal conversations, and can get lost and not know how much time has elapsed. The staff will tell me how many patients are waiting and how long.

Add paging system. Our paging system, the Butler system from LRS, was minimal cost (about $350 for the entire system, which is radio-controlled) and a great help. I have a paging system that enables me to call for support staff, like the optician, to come into the exam room.

Reschedule patients. Our policy is usually to see the patient unless another patient is waiting for their appointment, as I feel it is not fair to make the on-time patient wait. I’ve learned not to be afraid to sometimes reschedule patients for additional testing. This allow more time to do those important things I may have tried to skip over.

Weekly staff meetings. Having office meetings weekly, and discussing patient flow, and how to improve the patient experience, is vital to any practice for buy-in of the entire staff. Staff often has suggestions to make things work more smoothly. Frequent staff meetings to educate and talk through office policies are key to get the staff to perform at a high level with every patient. Having vendor reps come in for education is beneficial to help the staff run the equipment properly and understand how each piece of equipment works.

Add automated instrumentation. The best things we have done is add automated equipment to our routine, which speeds up the entire exam process allowing us to conduct more exams per day. Equipment like topographers, cameras and OCTs have given me more information about the patient before I enter a room, and I now spend more time in discussion with my patients than data collecting.

Let patients know what to expect. Most people are happy to wait 10 minutes, but will get antsy if it goes over that. Sometimes breaking up the components of the exam, so the patient only waits 5-10 minutes between components works well. The main thing is for the staff to treat every patient as an individual, and have a conversation with them about what to expect. Just running them through multiple tests with no explanation and no discussion will turn most people off.

Manage small talk. It is an art to have small talk, but be able to get back to the exam. This is different for every doctor, as each has a different personality. I like to say, after some small talk, “So, what brings you in today, and how is your vision?” Many of my patients have been coming in for many years, and I have gotten to know their families, so we talk about many things, but I know I have to watch the time and not get carried away. Most patients appreciate this.

Call optician. Use an intra-office phone, or paging, system, or text, to let the optician know it’s time to come to the exam room. This gives me a convenient way to sum up the exam and pass the baton to the optician and get out of the exam room.

When you fail in time management, apologize. If someone waits more than 15 minutes, I find that when I personally apologize, most patients appreciate this, and take it as me being sincere. Most have been to my practice before and know we usually are on time. They often comment on how long they wait at their other health care practitioners’ offices. Saying, “I am sorry for keeping you waiting, I appreciate your patience,” works very well.


David I. Geffen, OD, FAAO, is a partner in Gordon Schanzlin New vision-TLC in La Jolla, Calif. Contact:









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