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Veterinary Forum September 2008 (Vol 25, No 9)

Business Skills — Reclaim control of your appointment book

by Wendy Myers

    Do you have days when you feel more like a firefighter than a veterinarian? Rushing from one exam room to the next and working on sick pets can make your energy go up in smoke.

    Clients feel the heat, too. Wait time is an issue at most hospitals and the larger the practice, the worse it becomes. Research from 10,000 companion animal practices participating in the AVMA National Commission on Veterinary Economics Issues (NCVEI) online database shows a concerning trend. In a five-doctor practice, a client typically waits 19 minutes during a busy part of the day before being escorted into an exam room. The same client then waits nearly 9½ minutes to check out. For a 15-minute wellness exam, a client's waiting time totals 28½ minutes or double the length of the appointment itself, with the entire visit taking 43½ minutes.

    Following are some scheduling practices that can help you reclaim control of your appointment book.

    Schedule each appointment based on the reason for the visit. If you stack appointments every 15 minutes, you'll quickly get behind. If you choose an appropriate length of time for the appointment, you won't be playing as much catch-up. For example, schedule 20 minutes for adult wellness exams, medical progress exams, sick pet exams for illnesses other than vomiting or diarrhea and follow-up puppy and kitten visits. New clients, senior pets, illnesses involving vomiting or diarrhea and patients with such problems as limping that likely will need radiographs or other diagnostics require 30 minutes.

    Allow 40 minutes for the first puppy or kitten visits, with staff handling client education while the doctor is double-booked for two 20-minute exam slots. Using a checklist of puppy and kitten discussion topics can ensure consistency and keep appointments on time.

    Note the medical concern in the schedule. When a client calls to book an appointment, look up the pet's computer record to learn which services are due. For example, my 20-year-old cat Ollie would have a senior wellness exam, which includes vaccinations, senior blood panel, urinalysis and intestinal parasite test, noted in the appointment schedule. The number of services needed alerts the receptionist to schedule 30 minutes for a senior wellness exam rather than the usual 20 minutes. Detailed notes give doctors and technicians a heads-up about the possibility that diagnostic testing may be required.

    Use color coding to schedule visually. Organize each day with a balance of wellness and sick pet exams. If you stack one sick pet visit after another, the schedule will domino into disarray. Have receptionists color-code the appointment book to better plan the day's flow.

    Use colored highlighters for a paper appointment book or background colors on a computerized schedule. Create a color legend, such as:

    As you book appointments, balance wellness and sick pet exams. For example, schedule well-sick-well appointments in a group rather than sick-sick-sick. A sick pet may require extra time and diagnostic tests. When creating the schedule, strive for a checkerboard of colors. You want lots of variety — not too much of any one color. A snapshot of a visually layered schedule looks like the box .

    As shown in the sample, block urgent care slots into the schedule to reserve appointments for sick pets that must be seen that day. The number of urgent care slots depends on the number of doctors, staff and exam rooms. For a one- to two-doctor hospital, two or three 20-minute slots per day are usually sufficient. For Doctor 1, try one 20-minute slot mid-morning and another mid-afternoon, such as 10:00 to 10:20 am and 2:00 to 2:20 pm. For Doctor 2, block urgent care slots from 11:00 to 11:20 am and 5:00 to 5:20 pm. Stagger urgent care slots so that doctors do not see sick patients at the same time, which could cause delays in the treatment area if the case workup becomes more extensive than anticipated. Schedule the last urgent care slot 60 to 90 minutes before closing.

    Practice teams appreciate urgent care slots to maintain control of their day and make clients happy. Initially, practice owners may be concerned that blocking a few urgent care appointments each day will result in lost revenue. But receptionists know that clients always are calling about sick pets that must be seen the same day. To reassure practice owners, I recommend having receptionists open up blocked urgent care appointments 60 to 90 minutes before the time slot if a client has not called about a sick pet. A client calling about an exam and vaccinations could be put into the urgent care slot if it is not filled.

    Charge a slightly higher fee for sick pets because these appointments require more critical thinking, diagnostic testing and staff time, meriting extra compensation. If your wellness exam is $45, charge $50 to $52 for a sick pet exam.

    Make appointment and surgery confirmation calls. This courtesy reminder helps clients arrive on time.

    An example would be, "This is Wendy from Myers Veterinary Hospital calling to confirm your appointment for Ollie with Dr. Myers tomorrow beginning at 10:20 am. Please remember to bring a teaspoon-sized fecal sample that is fresh within 6 hours. We look forward to seeing Ollie and you tomorrow at 10:20 am. If you have questions or need to reschedule your appointment, please call us at 720-344-2347."

    The word "beginning" tells the client to arrive before the appointment time, not be down the street getting coffee. Compliance for intestinal parasite testing also will improve by reminding clients to bring a fecal sample. Be specific about the size and freshness based on your protocol.

    Surgery confirmation calls also help clients remember fasting instructions and to leave ample time for check-in.

    For example, "This is Wendy from Myers Veterinary Hospital calling to remind you of Ollie's surgery tomorrow. Please withhold food after 8:00 pm tonight. Your surgery admission appointment is scheduled for 7:45 to 7:55 am with a technician, who will spend 10 minutes reviewing the consent form, answering your questions and getting numbers where we can reach you on the day of surgery. Please allow at least 10 minutes for Ollie's admission to the hospital. If you have questions, please call us."

    Remove "drop off" from your vocabulary and hospital forms. This phrase implies that the surgery admission process takes seconds. When admitting a patient for surgery or dentistry, you need a minimum of 10 minutes to sign consent forms, collect phone numbers, answer the client's questions and explain when you will call following the procedure.

    Offer a day admission. If the schedule is full but a sick pet needs to be seen, offer the client a day admission. Do not call it a "drop off." Day admission communicates that the pet will be hospitalized for the day and will receive needed medical treatment.

    Charge a day of hospitalization for this convenience because you need to cover the cost of nursing care, cage occupancy, food and water. Consider having two hospitalization fees: a 12-hour rate (for day admissions up to 12 hours) and an overnight rate. If a doctor is not available to admit a sick pet to the hospital, a technician should ask history questions and get the client's cell phone number. Have doctors and staff create a day admission questionnaire so that specific information about the pet's clinical signs can be gathered in case the client cannot be reached by phone while the patient is hospitalized.

    By proactively planning for sick pets, you'll be able to trade in your firefighter's coat for a doctor's lab coat. Simple strategies can reduce staff stress and increase client satisfaction.

    For more information:

    For checklists and exam report cards, you can order The Veterinary Practice Management Resource Book or the CD at 720-344-2347 or www.csvets.com.

    National Commission on Veterinary Economic Issues online database, www.ncvei.org.

    NEXT: Case Report — Unusual Case of Acetaminophen Toxicity

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