Kennedy James G, Hsu Julian T
Department of Family Medicine, University of Colorado, USA.
Fam Med. 2003 Oct;35(9):666-70.
Open access is one method of improving the quality of clinical practice. Leaving the majority of appointments open to be scheduled the same day allows patients to have control of their access to care. These appointments can be used for all visit types, including physical exams. Our objective was to implement this system to improve efficiency, and patient/provider satisfaction, while maintaining financial profitability.
We implemented open access at our academic practice on January 2, 2002. Clinical teams are essential for continuity, and implementation required extensive patient, provider, and staff education. We prebook the first three patient appointments for patients requiring language interpretation, prearranged transportation, and procedures. A phone triage system is still necessary for clinical questions or hesitancy about the system.
Charges and revenues have increased since implementing the new system, as have patient satisfaction, visits per full-time equivalent, and total monthly volumes. Patient satisfaction is improved, as measured by the percent of abandoned phone calls, average time to make appointments, and the number of no-shows. Nursing work, as measured by triage, nursing callbacks, and bumped appointments, has declined markedly.
Open access has improved revenue, simplified office processes, decreased nursing work, and improved patient satisfaction without any increase in provider time or clinic expansion.
开放预约是提高临床医疗质量的一种方法。将大部分预约时段留作当日预约，能让患者掌控自己获得医疗服务的机会。这些预约可用于所有类型的就诊，包括体格检查。我们的目标是实施该系统以提高效率、提升患者及医护人员满意度，同时保持财务盈利能力。
我们于2002年1月2日在学术医疗实践中实施了开放预约。临床团队对于连续性至关重要，实施过程需要对患者、医护人员和工作人员进行广泛教育。对于需要语言翻译、预先安排交通和进行检查的患者，我们提前预约前三个患者就诊时段。对于临床问题或对该系统的疑虑，电话分诊系统仍然是必要的。
自实施新系统以来，收费和收入有所增加，患者满意度、每全时当量就诊次数和每月总量也有所增加。通过放弃电话呼叫的百分比、平均预约时间和爽约次数来衡量，患者满意度得到了提高。通过分诊、护理回访和被挤掉的预约来衡量，护理工作明显减少。
开放预约提高了收入，简化了办公流程，减少了护理工作，提高了患者满意度，而无需增加医护人员工作时间或扩大诊所规模。
