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.

The cause

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.

Some remedies

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 think big.

• 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 those things.
• 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 rooms?
• 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 needed.