Have You Considered Your Practice’s Patient Flow?

Your patients’ experiences in your optometry practice are of paramount importance. It determines whether this patient returns, whether they are likely to spend more or less money, whether they decide to follow your recommendations, and whether they’re likely to recommend your services to someone else.

Patient flow refers to the movement of patients through your clinic. It starts from the point the patient makes an appointment, to the care they receive from the optometrist to the attention from the optical dispensers, to any follow-up required after they've stepped outside your doors. If you haven’t done so already, giving careful consideration to your patient flow can improve operational efficiency, patient safety, and patient satisfaction. Here are some factors to think about.

How easy is it to make the right appointment?

Few things are more frustrating than ringing a healthcare practice to make an appointment only to spend 10 minutes on hold or for the phone to ring out unanswered. Nowadays, many optometry practices are utilising online booking systems, such as MyHealth1st or HotDoc. This can greatly improve efficiency (if only to free up the receptionist’s phones a little) but can also cause problems if not set up properly. For example, if an 8 AM appointment time appears as available on the website, but your optometrist doesn’t actually start until 9 AM. Some appointments may benefit from being organised over the phone with a front-of-house staff member who can see the clinical notes. Your optometrist may prefer to see a patient for one hour instead of the standard 30 minutes for their next review or may have left a note to remind the patient to bring in their list of medications at their next visit.

It's worth ensuring your front-of-house staff are well-trained in making appointments and all the specifics of organising an optometry consultation. This can include reminding diabetic patients coming in for a dilation that they need to organise transport home afterwards and to bring sunglasses. Any patients mentioning they've been seeing floaters or flashes should also be warned about the likelihood of a dilation and the associated transient inconveniences post-drops. Contact lens patients coming in for an aftercare appointment to renew their contact lens prescription would ideally be advised to insert their lenses at least an hour before their appointment for an accurate assessment.

Can you upskill your dispensers or optical assistants to take on more clinical duties?

Of course, the bulk of an optometric examination must be performed by a qualified optometrist, both for the sake of legitimate Medicare billing but also to provide appropriate, quality care. However, there are some aspects that a trained dispenser can perform. This can include:

• Contact lens teaching appointments. Though the optometrist is responsible for selecting the appropriate trial lens and assessing fit and vision after, a dispenser or assistant can be trained to teach a patient how to insert and remove the lens, as well as discuss lens hygiene.
• Visual field testing. An optometrist should set up the test, be available for the duration of the test, and discuss any results with the patient,¹ however, a dispenser may sit with the patient during the test to ensure the patient remains focused and comfortable.
• Fundus photography. Many optometry practices will conduct retinal photography as part of “pre-testing” before the patient sees the optometrist.
• Tonometry. Whether non-contact or iCare tonometry, a dispenser may be trained to conduct IOP measurements with these techniques. Again, many practices will include tonometry as part of pre-testing.
• Autorefraction. This can provide a useful starting point for the optometrist to refine with subjective refraction.

By upskilling your dispensers or assistants to undertake some of these tasks, your optometrist can either spend more time with the patient within their allocated consultation or move on to the next appointment. It can also mean the patient doesn't need to return for a second visit to do a contact lens teach. Instead, it can be immediately passed onto an available dispenser after seeing the optometrist.

Does the arrangement of your equipment allow for efficient patient movement?

The positioning of your equipment is often dictated by how much physical space you have available in your practice. However, if you have the option, it can improve your patient’s experience by ensuring your equipment is arranged in a logical manner.

Consider the positioning of the equipment you use the most. For example, trial lens kit and trial frame, slit lamp, fundus camera, OCT machine, and VFT machine. It makes little sense to keep the trial lens set at the opposite end of the room from the chair – you’d certainly get your step count up during refractions! Similarly, if you’re in the habit of taking fundus photos of every patient, why keep your retinal camera in another room? Instead, if you have the choice, a camera positioned on a sliding slit lamp table would be perfect. Doing this can save time and win the appreciation of your patients with limited mobility.

Some practices keep their VFT machine in the same consulting room, while others may have a separate room. If you are going to upskill your staff to perform VFTs, of course, it makes the most sense to keep this machine in a separate room so you can continue to attend to the next patient.

Do you have a system to ensure patients receive the appropriate follow-up?

Follow-up can refer to either clinical or dispensing concerns. Your patient may have seen the optometrist for a red eye but is flying interstate the next day. Alternatively, your patient may be a first-time multifocal wearer. Patients appreciate a phone call from the clinic to see how they’re getting along with their new glasses or to ensure their sore, red eye is resolving as expected (or what to do if it isn’t).

Remembering to call the patient on the day or time you promised them you would can be as simple as writing a note in your appointment booking system. Consider creating an appointment column specifically for follow-ups and ensure this is checked regularly every day. Some practices may prefer to use a whiteboard to jot down patient names, or even a notebook. Ensure everyone knows to mark the item off as completed, so the patient isn’t receiving multiple calls from different staff.

Summary

Remember that all members of your staff play an important role in smoothing out the patient experience. It’s worth listening to their input as a dispenser will often get a different perspective of the patient flow compared to, say, the optometrist in the consulting room. Although perfecting your practice’s patient flow can take time and some trial and error, it’s certainly worthwhile investing the effort.