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Walk-in outpatient services have been around for years. “But the culture has evolved into this being more the norm,” says Stewart Rasberry, MBA, manager of patient access, registration, and the revenue cycle at St. Bernard Parish Hospital in Chalmette, LA.
Hospitals are capitalizing on this trend. “For competitive market growth and patient satisfaction, there has been heavy promotion of same-day services,” Rasberry notes. Steady growth in the volume of walk-ins is the predictable result. Additionally, many hospital mission statements emphasize that patients are the number one priority, which is consistent with same-day services. St. Bernard Parish Hospital is part of the Ochsner Health System, which defines its core values as “Patient First, Compassion, Integrity, Excellence, and Teamwork.”
Servicing the growing population of walk-in patients and expanding hours to evenings and weekends “are just the next steps in a patient-first mentality,” Rasberry adds. Accommodating both scheduled and walk-in patients is a challenge for patient access departments trying to meet the needs of both groups. St. Bernard Parish recently expanded service hours due to pressure to accommodate patients wanting same-day services, mostly for lab work and radiology. “Over 50% of our outpatient volume is from walk-in patients,” Rasberry reports.
Previously, services were only available Monday through Friday from 8 a.m. to 5 p.m. Now, earlier and later hours are offered on weekdays, starting at 5:30 a.m. and ending at 7 p.m. Saturday hours are 8 a.m. to 5 p.m. “Demand for after-hour or weekend appointments is due to a shift of both parents being in the workforce, and older persons having delayed retirement years,” Rasberry says.
The biggest challenge with walk-ins? The effect they have on scheduled patients. For instance, if 10 mammogram appointments are available on a given day, and all are filled with scheduled patients, there are no slots available for walk-ins. “Department workflows must be flexible to accommodate the same-day requests in an equally timely manner,” Rasberry says.To accomplish this, schedules make allowance for walk-ins. “Of course, if you have multiple walk-in patients for the same service at the same time, this has a ripple effect throughout the day on seeing the scheduled patients on time,” Rasberry cautions. All patients are seen in a timely manner. However, some scheduled patients end up receiving service slightly after their scheduled appointment time. This all depends on the number of walk-ins on a given day. On a day with few scheduled patients, some registration staff might be reallocated to other areas by the middle of the day. “We utilize the reallocated staff for pre-registration of the future scheduled patients,” Rasberry says.
This helps expedite their check-in event and best prepare for the other walk-in patients. “If there is a large volume of walk-in patients that afternoon, it is difficult to service the patients,” Rasberry acknowledges. Inpatient workflows also have been affected. Departments such as radiology and the lab have to balance servicing hospitalized patients with walk-ins. Still, Rasberry describes expanded hours of operation as a “win-win.” Patients win because more available appointments means easier and quicker access, and patients don’t need to miss work. The facility wins by seeing more patients in a day. “This increases patient volume and revenue,” Rasberry adds.