Staff Management

Avoid Pre-Testing Bottlenecks

By Ryan Wineinger, OD

Pre-testing occupies a major portion of a patient visit. Time is money. Schedule strategically to avoid long wait times.

Most doctors know how many patients they can handle each day in their exam room, but not enough consider how many patients their pre-testing area can handle at one time. At my practice, we plan patient visits with the needs of the whole visit in mind, including the time necessary to conduct thorough pre-testing.

Practice Profile

Wineinger Vision Associates,

Shawnee, Kan.

Ryan Wineinger, OD

Locations
One

Doctors
Two

Opened
35 years ago

Comprehensive Examinations
14 to 16 per doctor per day
(with follow-ups/special testing/red eye visits added to that)

Doctor’s In
Six days per week, with half-days on Thursdays and Saturdays

Right Instrumentation Saves Time
In our independent practice we do five tests in the pre-testing room: auto-refraction, NCT (non-contact tonometry), Lensometry, FDT (screening visual fields) and Optomap retina imaging. The most significant thing we’ve done in the last two years to decrease the amount of time spent in the pre-testing room is to bring in digital refracting equipment. Our doctors still do the refracting in our office, but with the digital system our staff has the ability to quickly save all of the information from the auto-refractor and the lensometer and feed that directly into the refracting system in the exam room. Previously they either had to enter all that data into our electronic records or write all that data down at the time of screening then enter it in the EHR in the exam room. Everyone talks about how digital refracting can speed up your exam times, but we’ve noticed more improvement in our exam room than I would have expected.

We recently purchased the new Optomap that will be coming out in the spring. This instrument makes it easier to capture images for our staff, more comfortable for the patient, and provides better images than our current equipment.

Don’t Double-Book Patients
The other thing we’ve done to make pre-testing run smoothly is adjust our doctors’ schedules so that there are very rarely two exams coming into the office for the same appointment time. Instead, one doctor is seeing exams at the top and bottom of the hour while the other is seeing exams at :15 and :45 on the hour. This helps reduce patient waiting time and has been a good adjustment for our practice.

Create Testing Regimen and Track Time

Our staff is in the pre-testing room anywhere form five to 12 minutes depending on the age of the patient. In our current Optomap policy we photo document every patient who comes through the screening room down to age 5. Previously patients had to decide if they wanted that test done which increased the amount of pre-testing time. So, switching policies not only allowed us to increase the amount of images we take, but it also reduced the amount of time patients are in the pre-testing room.

Cross-Train Staff

All of the staff in our practice are cross-trained. So at any point in a day I can have any staff member take an Optomap photo or run an FDT. Cross-training really helped us to increase patient flow. In previous years we used to have a pre-tester for each doctor and that would gum up the screening room waiting for the testing. Now that anyone in our practice can jump up and do any test, we are rarely waiting on staff to finish up a task to get a test done. So, we rarely increase staff just for pre-testing, because any staff we bring on will be trained to screen.

Three Steps to Smoother Pre-Testing

Pre-testing may be the area of the optometric practice most prone to bottlenecks. Through careful scheduling of patient appointments and doctor time and cross-training staff, we were able to master this potential logjam of office traffic. Here are four key solutions we implemented:

1. Enter information into an EHR system while patients are being tested. If using electronic records, have a way to enter that data in the pre-testing room–whether that’s entering actual test data, or the ability to enter history information while a patient is in the screening room. For practices transitioning from paper, the FDT buys a moderate amount of time to get history information transferred over from a paper record into an electronic system.

2. Don’t walk to get a digital refracting system, run to get one! We’ve had ours for about three years now, and I still can’t believe how much time it saves the patient while they’re in our office.

3. Have multiple staff members able to do pre-testing. One of the best things we did is get away from the doctors having specific staff people doing pre-screenings for them. This alleviates the issue of having to wait on staff to free-up to have a patient pre-screened.

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Ryan C. Wineinger, OD, is co-owner of Wineinger Vision Associates in Shawnee, Kan. He can reached at: rwineinger@gmail.com.

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