For the last several months, Dr. Daniel Pepe, a London family physician, has been feeling a sense of control over his practice, a feeling that has been elusive for most of his medical career.  

The secret? A new approach to triaging patient calls. 

Dr. Pepe, who shares a practice with his wife, Dr. Cassandra Lin-Pepe, realized that they needed to be more intentional in how they worked and responded to patient concerns. He needed an approach that was calmer, more thoughtful, and less reactionary, he says. 

As a result, the office adopted a “team triage” approach, where the staff assesses which patients could have their concerns addressed by a non-physician, who needs to be brought in as soon as possible, and who would benefit from having imaging or lab tests conducted in advance of their appointment. Having the test results in hand when seeing the patient allows for a higher-value visit, says Dr. Pepe. 

To launch the new triage process, Dr. Pepe shortened his office’s voice mail message, instructing those experiencing an emergency to call 911 and advising everyone else to leave one message summarizing their concern. An email confirmation advises the patient that the doctor has been informed of their concern and the office will follow up. 

Managing patient concerns quickly by having the most appropriate person respond has done wonders for the culture of the practice and Dr. Pepe’s own stress level

All voicemails are then transcribed, made available to be read (or listened to) online, and triaged by staff. Each staff member accesses the common voicemail list throughout day, managing those messages that fall into their area of responsibility. If it is a question about paperwork, the practice facilitator pulls it off the list and addresses it. The medical receptionist will engage with the limited number of patients who pre-book appointments, and a nurse will follow-up on questions about immunizations and identify patients who need to be brought in as soon as possible.  The same team triage approach is applied when patients contact the office through its online portal.

Dr. Pepe also uses open-access scheduling, but only allows appointment bookings 48 hours in advance. Having appointments scheduled too far in advance resulted in too many no-shows. “If the patient’s symptoms resolved before the appointment, they would often not show or if they cancelled, the software didn’t always notify us of the cancellation.” He tries to keep pre-booked appointments limited to antenatal and well-baby visits, office procedures, and appointments for some chronic diseases such as diabetes. 

Managing patient concerns quickly by having the most appropriate person respond has done wonders for the culture of the practice and Dr. Pepe’s own stress level. “We feel like we have some control, finally, and that is a great thing.”  

Making the Most of Your Time 

Scheduling office visits in rigid blocks of time does not account for differences in the complexity of each visit, which can make it hard for physicians to stay on schedule. A 2022 article published in the American Academy of Family Physicians journal recommends scheduling “on a wave” (e.g., booking two patients on the hour and one on the half hour) allowing physicians the flexibility to shift time from patients who don’t need it to the ones who do.  

Other strategies for optimizing patient appointment time include:

• building in a buffer of unscheduled time on certain days 
• allowing staff to take on duties a physician does not need to do (e.g.  checking blood pressure or obtaining a medication list) 
• having more than one examination room if a physician has staff completing much of the pre-visit and post-visit work 
• scheduling follow-up appointments at the conclusion of the current visit
• using a robust EMR that includes scheduling features to allow you to streamline appointments, reminders, and patient information management 
• using block/cluster scheduling to group together similar appointment types (e.g. well-baby visits) to optimize time and resources 
• using automated reminders to reduce no-shows and last-minute cancellations 
• monitoring patient flow and adjusting schedule based on historical data to improve efficiency (e.g. creating more flexible scheduling during flu season)  
• using an online booking system 
• integrating telemedicine in between office visits