The "Same Day Access" Clinic Model: A New Alternative

Purpose:Improving access to a healthcare provider is one of the frontline issues facing the USA today and the Joint Commission for Hospital Accreditation (JCAHO) has mandated hospitals to improve access to both primary care physicians and specialists. The Oral and Maxillofacial Surgery (OMS) clinic at Boston Medical Center (BMC) had been in existence since the early 1900’s, and traditionally served lower income, uninsured and Medicaid populations with a 100% walk-in, first-come; first-serve model which presented daily challenges including patients waiting 4-6 hours or more prior to evaluation, overcrowded waiting rooms and chaotic clinic work flow. In response to the changing times, the clinic initially transitioned from this 50+ year-old 100% walk-in model to a new 80/20 mix of walk-in and scheduled appointments in an effort to minimize patient dissatisfaction and maximize resources. However, it was noted that patients scheduled for appointments had high no-show rates due to long wait times before the appointment and many patients who were in need of immediate access to care for dental emergencies could not be accommodated. In the fall of 2013, thus, a search for a better outpatient clinic model was initiated.

Methods: Patient population and demographics was evaluated, clinic resources were assessed and clinic workflow and average treatment time per patient calculated. Once these data were analyzed, a decision was taken to completely abandon the pre-existing walk-in clinic and appointment scheduling concepts and instead, a  novel “same day access” clinic was opened in March 2014. All referring doctors were informed of the change and prospective patients were instructed to call a dedicated telephone line (617-414-ache) starting at 7 am every weekday morning to request a consultation appointment. The operators would pre-register the patient and make an appointment for them to be evaluated by an OMS the same day.  Once the daily schedule was full, an automated message informed every caller and instructed them to instead call in the following day for an appointment. Access and volume reports, along with a specifically designed “Time Study” were then used to validate improved clinic efficiency.

Results:Access to care significantly improved with 96% of patients being scheduled and seen within 14 days despite telephone call volume increasing by 34% within the first three months of implementation. The no-show rate decreased from 36% to 21% while clinic patient volume increased by 2.5% per day when compared to the previous model. Overall, safety improved through better workflow and patient experience was enhanced through reduced wait times (from an average of 6 hours to 1 ½ hours). After its implementation, staff and doctor morale was found to be significantly higher when surveyed by the hospital administration. Feedback from our referring physicians and dentists was extremely positive.

Conclusions: Implementation of the same- day access clinic concept was successful in improving patient access to OMS care while streamlining workflow and increasing patient satisfaction. This is an exciting and new concept to outpatient OMS care and development of similar “call centers and clinics” may be viable option for many hospital-based clinics suffering from volume, revenue and access issues. Based on our experience, it appears that its adoption improves local working conditions and may promote faculty and ancillary staff retention while maintaining optimal quality control.

References:

1) Murray, M. Tantau, C. Same-Day Appointments: Exploding the Access Paradigm. Fam Pract Manag. 2000 Sep;7(8):45-50.

2) Boelke, C. Boushon, B. Isensee, S. Achieving Open Access: The Road to Improved Service & Satisfaction. Med Group Manage J. 2000 Sep-Oct; 47(5): 58-62, 646, 68.