Medical Professional Publications

What We Learned by Offering Walk-In Hours to Our Patients: Our Ongoing Journey

(From the April 2017 Issue of MedStat)

Primary Care Matters

The articles in this ongoing series will feature news and items of interest to pediatric primary care providers. If you would like to contribute, email William.Long@NationwideChildrens.org.

Article written by Tim Teller, MD, FAAP of Hilliard Pediatrics.

Walk-in ill appointments are an attractive possibility for parents. They can see the doctor or nurse practitioner promptly, they do not need to make an appointment, they can receive information that may change their work and school day plans, and it may reduce over-night and early morning worries about their child if they know they can be seen early.

Walk-in ill appointments can cause anxiety for doctor’s offices. Are you going to be over- or under-staffed? Will people come in for walk-in hours when their chief complaint warrants an appointment? What will we do when more walk-ins occur than can be accommodated? Will we have the staffing for walk-ins? What hours will we make available for walk-ins?

We at Hilliard Pediatrics pondered all of these questions before (and after) starting our walk-ins. We were encouraged by our office manager at the time to offer walk-ins. It was approximately eight years ago. My memory is that we started in October — not too busy with illnesses (most years). After much discussion, we started 8 a.m. to 9 a.m. walk-ins Monday through Friday. We let families know it was routine illnesses such as ear aches, sore throats, acute rashes, pinkeye symptoms and coughs. We also emphasized that although we have same-day-scheduled ill visits on Saturday, we would not be doing walk-ins on Saturday.

Initially, although we would have at least two doctors here in the office, we initially saw a handful of patients during walk-ins. If a doctor was having office hours that day and was not making hospital rounds that morning, you were expected to be in the office and seeing patients for the walk-in hour. We tried to keep our front office informed each morning about which doctors where going to be there to help out. This was especially important during those years that newborn rounds at the hospital and our walk-ins overlapped.

Over time, our walk-in hour has been getting more and more popular. Typically, Mondays and Fridays are the busiest. The numbers are seasonal, with more patients here for walk-ins during the winter. We continue to have walk-in hours twelve months a year. Most days, we can see each of the patients who arrive before 9 a.m., however we occasionally need to give patients a scheduled appointment later that day.

We have needed to reinforce the importance to our staff and the patient families the need to refrain from seeing something more complicated during those hours. Generally, parents have been understanding. We will do our best to schedule the chronic headache, chronic stomachache, and other potentially complicated issues with their primary care doctor in the very near future. Our website and patient literature give details about appropriate use of the walk-in hours. Our Facebook page has also been a source for families with updates about our walk-in hours. Of note, we only see established patients during our walk-in hour. We schedule an appointment for those who request a well visit, a complex ill visit, or a new patient visit.

As our hour has gotten busier, we contemplated stopping our newborn rounds. For the past year, we have stopped our newborn rounds and it has allowed for more staffing of the walk-in hours. Subsequently, families seemed to have spread the word about our availability at this hour and we seem busier than ever. It is typical to have 15-25 patients on a Monday morning.

We did have concerns about paying for staffing with walk-ins when we might not always be busy. However, overall we are busy enough that it has been a wise use of staff time and expenses. As doctors, on a slower day, we find something to do – catch up on charting, clean out our in box, clean off our desk, etc.

One of the greatest benefits for the doctors in our practice is that after-hour and early morning phone calls seem significantly less when families know their child can be seen by 9 a.m. the next day. It also potentially reduces the flurry of phone calls once the phones turn on. Some parents who have been up all night with a child with an earache who can get in for a walk-in visit at 8 a.m. are less likely to call frantically at 9 a.m. for an appointment. If late in the day a parent calls for their child to be seen and we do not have same-day appointments available, being able to offer walk-ins the next day potentially encourages someone to visit us the next day and not the urgent care after hours.

We have found that walk-ins have offered benefits to our office and our patient families. We have found them popular. We would strongly encourage offices who are considering offering them to ensure that staff are on board with specific times that the office will accept walk-ins and what specific chief complaints the office will see for walk-ins. Ensuring that this information is well advertised to families will also ensure office satisfaction with the experience.

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