Online check-ins help urgent-care clinics manage patient throughput

Urgent care is unpredictable. Some days, there’s downtime, other days, a patient walks in and is greeted by a wait of multiple hours.

“Urgent care in general faces a lot of challenges with inconsistent wait times,” said Andrew Schenk, director of Deaconess Clinic Urgent Care, part of Evansville, Ind.-based Deaconess Health System. “We’d have a location that would be very busy one day, and then we’d have another location within five miles that wouldn’t be busy.”

That makes it difficult for urgent-care programs to manage staff productivity and patient volumes. And that’s no small challenge, as patients are increasingly expressing interest in urgent care, with one study in JAMA Internal Medicine estimating a 119% increase in visits to these clinics between 2008 and 2015.

So to help make day-to-day volume more manageable across its urgent-care sites, Deaconess in 2017 debuted a seemingly simple, patient-facing solution: online check-ins.

Now, when a patient visits Deaconess’ website, they can see estimated wait times for each of the health system’s urgent-care locations—the same projected waits that they would experience had they walked into a clinic in person. From there, they can select an available time slot for a clinic visit, essentially holding their spot as if they were checking in at the clinic’s front desk.

The software tool, developed by Experity, isn’t just patient-facing: it does the back-end work of managing Deaconess’ queue of walk-in and online check-in patients, and crunches the data to provide both staff and patients with up-to-date wait-time estimates.

That’s helped Deaconess even out the number of patients seen in each of its clinics per hour, filling time slots that might otherwise have gone empty and reducing the number of patients who become frustrated with longer than expected waits. The online check-in tool, called Clockwise.MD, has led to a 70% decrease in patients who leave a clinic without being seen, Schenk said, likely as a result of patients being able to arrive at the time staff is ready to see them, or the ability to be directed to nearby locations with shorter wait times.

“This was a way for our whole service line to work together to manage the amount of patients that needed to be seen every day,” Schenk said.

Getting more patients into urgent care can create significant cost-savings for both healthcare organizations and patients, according to Dr. Donald Goldmann, chief scientific officer emeritus and senior fellow at the Institute for Healthcare Improvement. That’s mainly through helping to cut down emergency department utilization.

While online check-ins might seem simple in concept, they aren’t without challenges—chief of which is expectation management. While many patients appreciate the opportunity to check in online, it can create some tension with walk-in patients who aren’t familiar with the system; such as if a walk-in patient feels confused when they’re asked to wait a half-hour despite being the only person in the waiting room.

Here, communication is key, Schenk said. Front-desk staff at Deaconess’ urgent-care clinics are encouraged to provide explanations about how the queue works, and where each patient—including walk-ins—stack up in line. Schenk said the clinic also sends patients text messages if their estimated wait time changes, such as if a patient needing immediate care arrives at the clinic.

That’s why it’s important to frame the service as a check-in or way to save one’s spot, and not an appointment.

Deaconess’ strategy has seemingly proved successful. Between the year Deaconess’ urgent-care program implemented the online check-in service and the year prior, its patient-satisfaction scores rose 3%, according to Press Ganey data cited by Schenk.

Urgent Team, which operates four brands of urgent-care clinics in the Southern U.S., also emphasized the role patient expectations play in a successful online check-in program, and said front-desk staff at its clinics are trained to alert those in the waiting room when an incoming patient has checked in online.

“We’re managing that communication very carefully, so that nobody’s concerned that someone’s jumped ahead of them,” said Tom Dent, Urgent Team’s CEO.

Urgent Team began rolling out an online check-in service from technology company Solv in March, which it dubbed Hold My Spot. Urgent Team’s final urgent-care brand to go live on the service—a joint venture with Baptist Health in Arkansas—launched Hold My Spot in June.

Dent said it’s too early to draw conclusions on the benefits of online check-ins for the organization yet, but said 5% to 10% of its patients—depending on the clinic—are already using online scheduling.

“Capacity challenges are always active in the walk-in urgent-care business,” Dent said. “Online registration helps manage that queue.”