Optometric Management Tip # 282 - Wednesday, June 13, 2007
The Pretesting Bottleneck
Last week's tip about scheduling more patients per day brings up a common
dilemma that most practices face as they try to increase efficiency: a bottleneck
of patient flow at the point of pretesting.
As patient demand grows and as the practice attempts to process more patients
per day, there is an evolution of office procedures. This includes delegating
more clinical data collection, hiring more staff members, purchasing automated
instrumentation, changing the appointment schedule and time allotted per exam,
and adapting office space to serve new functions. These changes often occur
incrementally so the financial investment and staff training can occur over time.
Since there is typically only one set of automated pretest instruments and one
pretest room in the practice and since every patient receiving a full eye exam
goes through pretesting, it's understandable that a bottleneck can occur. In
many cases, the amount of time the doctor is spending with the patient is much
less than the time spent with a technician. If the doctor is working out of two or
more exam rooms (which is highly recommended for efficiency) there will be
many occasions where the doctor is standing around waiting for the next patient.
Here are some thoughts on ways to improve patient flow through pretesting so
the doctor stays busy. Remember that the potential increase in revenue that
occurs when you see more patients per day is very great, so it behooves us to
- Work with your staff to minimize the time spent in the pretest room in
order to turn it over quicker and allow the next patient to come through.
Just make them aware of the problem. We train staff to not take case
histories in the pretest area and to not reinsert contact lenses and try to
avoid chit-chat. They just wait until they move into an exam room for
- Don't have the technician perform stereopsis, color vision testing or blood
pressure measurement in the pretest area. Duplicate those inexpensive
tools and have one set in each exam room so those procedures can be
performed away from the bottleneck.
- The visual field screener is almost a self-testing device, so our techs read
the habitual Rx on the lensmeter during that time.
- You may need two or more pretest areas with duplicate equipment. This
is a big investment because autorefractors and retinal cameras are
expensive, but if you have enough patient demand it is the right thing to
do. Many doctors have multiple exam rooms, so why not multiple pretest
- You may need a larger office. I know many offices were designed when
the patient demand was much less, but moving to larger quarters is one
price of success. Embrace that and start looking for more space rather
than let your facility hold you back.
- You may be able to remodel your present office to allow rooms to function
in new ways. Making a large room into two smaller rooms can increase
productivity in some cases. Perhaps you can use off-site storage units to
free up space for purposes that increase production.
- There is always a dilemma about how many instruments to place in one
room. If you have only one instrument in a room the room turns over
quicker, but if you have to move the patient from room to room you can
waste a lot of time. If the test takes a longer time, like threshold visual
fields, a small separate room works well. Other considerations, such as
the need for darkness or privacy, enter into this decision. I like to have
most pretest instruments in one room on an arc shaped table so tests can
be completed quickly at one sitting, but special pretests, like retinal
photos can be done in a separate private room.
- As diagnostic technology increases, more special testing rooms are
Best wishes for continued success,
Neil B. Gailmard, OD, MBA, FAAO
Chief Optometric Editor, Optometric Management