The Flaw in Infusion Scheduling

With the goal of treating as many patients as possible with the highest level of care and respect, infusion centers often mistakenly operate under the logic that appointments must be scheduled well before they occur—that by booking early and locking things down, schedules will run smoothly and accommodate more patients. In reality, scheduling appointments with significant lead times, often weeks or months before the actual appointment, may actually cause more problems and serve fewer patients. Therefore, it is worth reconsidering how infusion centers schedule appointments.

Long Lead Times are the Accepted Norm

The rate at which schedules fill up is dependent on a variety of factors, including provider preference, treatment type, patient populations, and culture. To date, there have been 3 main drivers for establishing long appointment lead times as the norm:

  • Providers:
    Many physicians map out the entire treatment plan with a patient as soon as he or she is diagnosed. Providers want to get all clinic visits scheduled at once to ensure that treatment remains on schedule, and because infusions often occur on the same day, or at a minimum the same week, as these clinic visits, treatments are scheduled in conjunction. In addition, providers are perpetually overbooked, yet they somehow need to ensure that patients are seen at the right times according to their plans. To assist these plans, staff members will book infusions far in advance.
  • Schedulers:
    The individuals in charge of determining when patients come in tend to be hamstrung by requirements that dictate how they schedule appointments. In addition, they want to be supportive of patients who need help. As a result, they book appointments with long lead times because they understand how difficult it can be to secure an appointment close to the day that treatment is requested, and they want to eliminate this stress for the patient.
  • Patients:
    It is often the patients themselves who request long lead times. They need to plan in advance to arrange transportation to the center or plan activities according to how they may feel in the days following treatment. In addition, by knowing that they have reserved a regular day and time for the duration of their treatment, patients gain a sense of control and predictability over an illness with a tendency to strip them of both.

All of these reasons are good and justifiable. The problem is that infusion centers have a responsibility that goes beyond guaranteeing appointments to those patients whose circumstances support them. The goal is to assist every patient who needs treatment, regardless of when the scheduler receives the request. Many times, practices designed to honor patient wishes can neglect, exclude, or penalize those who need treatment the soonest.

Long Lead Times Affect Patient Access

The root of the problem with long lead times is the likelihood of cancellations and no-shows. When there is a lengthy gap between the date the appointment is scheduled and the infusion, the likelihood that the appointment will not occur increases significantly. This stems from the possibility that a patient’s course of treatment may need to be adjusted by the provider based on the patient’s condition or other factors.

Although this is a common occurrence, it is difficult to close the loop between the clinics that determine the course of treatment and the infusion centers that execute it. Many appointments could be canceled weeks in advance, but often the most recent changes to treatment plans are not communicated to the infusion center.

It is nearly impossible to predict exactly how each day will unfold at an infusion center, but when schedules are clogged with appointments that could have been taken off the books much sooner, it means that other patients, including those with urgent needs, are not getting in when they otherwise could have. As a result, an infusion center’s limited resources are wasted.

There will always be patients who cannot keep their appointments because they are too ill or because their lab results do not meet the requirements for the scheduled treatment. However, the goal is to minimize the impact of these missed appointments, enabling other patients to take advantage of the opening and creating space for those who had to miss appointments to get back onto the schedule as soon as they are physically able.

Long lead times contribute to 3 main problems: schedules are clogged with appointments more likely to be canceled than to occur; appointments with out-of-date details remain on schedules leading to unpredictability on the day of the appointment; and schedulers have difficulty finding availability for add-ons or appointments with short lead times.

Guidelines for Improved Scheduling

Although these may sound like insurmountable issues, there are some basic steps that practices can take that will have a significant impact. They include reducing scheduling lead times, keeping scheduled appointments up to date, and reserving time slots for common short lead time requests.

Reducing Scheduling Lead Times

By not booking appointments too far out, cancellations and no-shows are inherently reduced. A general guideline for determining how far out to schedule appointments is to not schedule them beyond the point when the cancellation probability is greater than 50%. Finding the 50% mark will require some analysis of how the center’s schedule maps to actual days, but it will ultimately be worth the time spent examining the data to find more suitable lead times.

Keeping Scheduled Appointments Up to Date

It is important to establish a feedback loop between clinics and infusion centers so that when appointment details change, they can be reflected in the schedule as soon as possible. There are 2 primary ways to do this. First, staff members should make scheduling updates in real time, which can be difficult because providers often do not make these updates in a system shared with scheduling. Second, they should set up recurring review meetings with the clinical staff to discuss patient status and upcoming appointments. Based on these meetings, appointments can be scheduled or adjusted as needed. In addition, schedulers should be alerted to patients with conditions that are not stable as these appointments could change soon.

Reserving Time Slots for Common Short Lead Time Requests

With a little analysis of recent scheduling data, an infusion center can evaluate whether the number of cancellations and no-shows per day is greater than the requests for same-day add-ons. If it is, same-day appointments should be scheduled in these slots. If it is not, schedulers should look to block additional time each day to accommodate add-ons based on averages. If they notice that there are frequent demands for appointments within 1 week of lead time, it also makes sense to reserve some appointment slots and train staff to steer patients away from selecting these times as much as possible.

In summary, if a center’s schedules consistently stray from what was planned, long lead times could be the culprit. To address the issue, staff should look at the data to diagnose the situation, cap long lead times, and reserve slots for short lead times. If key stakeholders are resistant to a shift in scheduling protocol, centers should provide metrics that show how many patients are being rebooked, how frequently this happens, and how many patient slots could be opened if lead times were reduced.

Providers and infusion staff members ultimately want to help as many people as possible, so showing how many more patients could be seen and how existing patients could be better served is a powerful proposition. Ultimately, greater scheduling efficiency will improve patient care.

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