Revitalizing appointment system in the treatment and management of patients in health care service

Introduction

The need to revitalize appointment system in the treatment and management of patient in health care industry is to establish a policy in the outpatient system of seeing a doctor in the health care industry. But before we begin let us know what appointment is in health care industry. Appointment system can be defined in different ways:

Appointment system is the pre-timing of a patient visit to the hospital for consultation with a doctor. It can also be defined as the assignment of date and time for a patient to conveniently see a doctor. For appointment system to be revitalized in the treatment and management of patient in the health care industry is to establish a policy in the health care that will regulate the health team and patients. This will reduce patient waiting time and doctor’s overtime. Service time is not changed and patients are assumed to be punctual if they come for their appointment. Substantial reductions in waiting time can be obtained over traditional scheduling practice and the procedure easily implemented by the various schedule, one the optimal policy is established.

The medical doctors, nurses and health record personnel must rob minds together on how to make this policy work. The doctor can state how many patients to be clerked within this service time, the nurses dictates how many minutes would be spent in pre-clinic activities e.g. BP test, urine test, temperature counting etc. and the health records officer dictates and educates them on the procedure of documentation and movement of records.

Appointment can be revitalized when a patient is asked to put down his/her phone number for remembrance in case the patient forgets his/her appointment date. There should be disciplinary actions taken against any patient who fails to be punctual on his/her clinic days however, when giving time to patients, the record officer should checkmate the distance, the patient is from to enable them meet up with time i.e. a patient who stays at Ughelli and he/she is going to take treatment at Asaba should not be booked within a short interval e.g. of 8 – 9am but he /she should be booked within the interval of 10 – 11 am. But those living within Asaba, Ibusa and Ogwashi-Uku can be booked 8 – 9am. If this can be done appointment system can be lively in the treatment of patient in the health care industry. More also, appointment system can be lively when appointment is decentralized. This is to say that a patient should be given appointment in where he/she was admitted in the hospital. i.e. if a patient was admitted in emergency ward or medical ward etc in the hospital he/she should take appointment date there. If the hospital practices centralization system of appointment, it has a lot of disadvantage which can make patients to wait for a longer time and different ailment is subject together in one place. Under normal circumstances, doctors do not suppose to clerk more than twenty patients a day because there are new eases of patient. The doctor can settle down well and prescribe and observe the nature of the patients’ illness.

In addition, the health team should not be bias, they should treat every patient equal and the formula of first come, and first serve should be employed.

In conclusion, computer has achieved its importance in the health field, where every patient’s information is stored in the system. It has great advantage where patient information can link the record department and the doctor in charge of a patient. In 1966, Gallowing has used the computer to organize immunization appointments for the West Success Country Council from records of birth at the hospital. Computer is used in managing the outpatient appointment system which can enhance confidentiality.

Concept of appointment system

Appointment is an arrangement to meet or visit at a specific time.According to Ekete (2013), appointment system is the pre-timing of a patients visit to the hospital for consultation with a doctor. Appointment system is very important in the health settings. The aim of this is to minimize the waiting period of patients attending outpatient clinic. Therefore, it is an essential feature of an efficiently organized outpatient department. The satisfaction of this system lies in the benefit achieved by both the patient and the hospital staff concerned. The effectiveness depends upon continuous cooperation between the medical, paramedical, nursing, health records and administrative staff.

The initiation of an appointment system involves outpatient department. An efficient health record system is seen as a prerequisite of an effective appointment system because most of the appointment procedures depend on the registration and filling unit. Appointment system is required when an agreement is reached between the individual consultant and the health record officer on the number of cases to be booked for each respective clinic section, i.e. number of new cases, number of old cases and number of places left for emergencies. The health record officer should not book more cases than agreed number without the expressed consent of the attending consultant. Any appointment which fails to ensure that at least 70% patients are seen within the first thirty (30) minutes requires an investigation (British National Health Service, 2009).

Organization of appointment system

There are two methods of appointment namely:

1. centralized
2. decentralized

Centralized booking of appointment

Under this method all patients seeking for appointment go to the appointment section of the health records department to be booked by the appointment clerk (Ekete, 2013).

Decentralized booking of appointment

Under this method the appointment clerk has to move to the various clinics to book the patients for appointment. Also, the clerk has to go along with either a card or bounded register of each consultant to give appointment to the patients.

Types of appointment system

There are three major types of appointment system in the outpatient clinic.

1. Block or group appointment
2. Open house appointment
3. Timed or scattered appointment

Block or group appointment

This is a system of giving a group of patient a particular time to consult with the doctor and it is done in order of first come first serve.

Open house appointment

This is a type of appointment usually practiced in a emergency department for all patients that need dressing.

Timed or scattered appointment

This is a system whereby one patient is giving a specific time for consultation with a doctor and the next patient is given the next free time to consult with a doctor. That is, 1^st patient 8:00am, 2^nd patient 9:00am, 3^rd patient 10:00 am, etc. According to Osundina (2005) this method is best used where there is good of effective communication arid reliable transportation system.

Obstacles against appointment

1. Cultural background of the people
2. Illiteracy
3. Government policy
4. Lack of supervision of the clerks
5. Ratio of staff to patients
6. Inequitable of health facilities
7. Ignorance on the part of the patient
8. Overbooking of the clinics
9. Unscheduled public holiday
10. Favouritism, etc.

Procedures of appointment system

1. Make necessary transport arrangement
2. Make sure that all the patients given appointment are well informed on the date and time of the clinic.
3. Collect appointment slips from the patients.
4. Enter them in the visible strips
5. Ensure that appointments are given to the patients strictly on doctors instructions.
6. Avoid booking of patient on public holidays.
7. Compile the clinic list and send to the typist (Ekete, 2013).

Notification of appointment

For appointment system to be made, notification should be sent to the patient before their clinic day through any of the following means:

1. By appointment letter
2. Pre-registration label
3. Telephone

By appointment letter

This type of notification is written by the consultant or chief health records officer. Such a letter has to carry business reply coup envelop to enable the patient reply whether or not he/she will be attending the clinic.

Pre-registration label

This is used for documentation of patient’s identification details the moment he/she is given appointment before leaving the hospital. It is programmed on one side. Once appointment is made, pre-registration and additional note are sent to the new patients to know the appointment service available.

Telephone

Telephone helps in getting direct talk with the patient to notify him/her of their appointment through voice communication.

Appointment form/slip

This slip is initiated immediately after the patient has consulted with his/her doctor in the clinic. The best method of making appointment is by appointment slip because it provides adequate registration data in advance (Suleiman, 2010). Appointment should be documented on this slip if available to the record department for proper booking. The card carries the patient identity like full names (surname and given names), registration number and spaces for recording subsequent appointment.

Factors responsible for delaying of patients in the hospital

According to Ekete (2013) many factors are responsible for delay of patient in appointment system, such cause are as followed:

1. Mis-filing: when the case notes are placed in the wrong position.
2. Mis-laying: is the careless placement of case note aside the health record library.
3. Over booking of clinic
4. Shortage of staff
5. Retention of patient record in the ward
6. Lateness of doctor to clinic
7. Lateness of patient
8. Transposition of number i.e. changing of number
9. Teaching of medical student during clinic hour.
10. Absence of medical record staff from clinic
11. Order in which the patient are seen.

Possible solution to patients’ delay in the hospital

1. Inform the consultant prior to the clinic day the total number of patient expected at clinic so he/she (consultant) can time his/her self
2. Communication between the health team and patient should be cordial.
3. Patient’s medical record should be pulled or traced three to four days prior to the clinic day.
4. There must be an existing cooperation between the medical, nursing, auxiliary service and health record staff
5. There must be adequate preparation of comprehensive nursing care.

Review of appointment system for effective health care delivery

For effective health care delivery system, appointment system should be reviewed monthly or bi-monthly and it is the duty of the health record department to carry out the job. This is done by finding out whether the clinics are over-booked or if the record department is totally negligent in this service.

Advantages of appointment system

The following are advantages of appointment system:

1. Appointment system minimizes time wasting of patients.
2. It gives adequate preparation for nursing services.
3. It assists patient to obtain adequate health care
4. It supports efficiency of health record regarding patient time of arrival and living the hospital after treatment.
5. The system enable the health record personnel prepare clinical notes in advance
6. It gives patient the opportunities to make domestic and transport arrangement in advance
7. It assists hospital to established suitable out patient unit and services

Disadvantages

1. It create avenue for corruption
2. It promotes godfatherism in health care
3. It creates room for enmity.

Equipment for booking appointment

The following are equipment used for booking appointment:

1. Diary: This is commonly used in decentralize system of appointment by the physician to book his/her patient for followed up.
2. Visible card/strip: This is a strong card that contains the name of patient, hospital number and consultant respectively.
3. Register: Register is a bounded book used to record names, marriage, deaths or a designed book use to record all vital information such as identification data, marriages, deaths, etc. (Adams, 2013).
4. Calendar: It is used calculate patient appointment date and to also identify public holiday.
5. Reference card: This is a small card given to a patient to take home and to be brought back at every visit or clinic day. It contains the name of the patient, sex, hospital number, clinic where he/she is receiving treatment and a space to write down the patient next appointment date.
6. Computer: Modern technology has brought electronic into health record maintenance. Therefore, computer can be used to maintain appointment of patient visiting time (Ayilegbe, 2008).
7. Appointment cardex: This card contains names of patient, date and time, hospital number, consultants in charge of the patient.

This is the diagram of the cardex card used in FMC (Federal Medical Centre), Asaba.

References

Adams, G.R. (2013). Health Record Management III (HIM 211). (Lecture Note). Delta State School of Health Technology Ofuoma – Ughelli, Health information Management.

Affiah, S.B. (2004). Health Records and Your Health.

Ayilegbe, B.K. (2008). Essence of Documentation in Health Care Institution. Gyadi – Gyadi, Kano State; Debis-co Press & Publishing Company.

Ekete, C.A. (2013). Record Management (SET 221) (Lecture Note). Delta State School of Health Technology, Ofuoma – Ughelli, Department of Health Information.

Elemi, E.E. (2011). Introduction to Health/Biostatistics. Calabar, Cross River State; Ken. J. Press.

Guptau, S.C. (2008). Fundamental of Statistics; Himalaya Publishing House.

Osundina, K.S. (2005). Principles and Practice of Health Records Management. Osun State: Osundina Publication.

Suleiman, M. A. (2010). Introduction to Health Record Management. Kaduna State: Covenant Eagles Printing & Publication.