# Scheduling Appointments

Contents

[6.1 About Scheduling Appointments 6-2](#about-scheduling-appointments)

[6.2 Appointment Scheduling Process
6-2](#appointment-scheduling-process)

[6.3 Exceptions to the Standard Scheduling Process
6-3](#exceptions-to-the-standard-scheduling-process)

[6.4 Preventing "Did Not Keep Appointments" (DNKA)
6-3](#preventing-did-not-keep-appointments-dnka)

## About Scheduling Appointments

The purpose of scheduling appointments, utilizing the **RPMS
Scheduling** application, is to:

-   Distribute workload as evenly as possible for the providers and
    nurses.

-   Reduce unnecessary wait times.

-   Encourage continuity of care.

-   Improve the patient-provider relationship.

-   Assure timely follow-up of patients with chronic diseases.

Whenever possible, patients will be offered their choice of several
dates and times to better assure compliance and customer satisfaction.

## Appointment Scheduling Process

-   If appointment scheduling is centralized, patients will be directed
    to the Appointment Scheduling clerk for a future appointment.

-   If appointment scheduling can be made directly with each clinic, the
    patients can either schedule an appointment directly in person or
    call the Appointment clerk directly.

-   If the clinic has restrictions which require a referral form from a
    primary care provider or approval of the staff of the clinic, the
    clerk or other person entering the data into RPMS should first
    obtain the authorization according to the clinic's appointment
    policy.

-   The appointment clerk will access the RPMS Scheduling application
    using his or her assigned access codes and current RPMS codes for
    the clinic.

-   The clerk will offer several times and dates for the clinic or
    specific provider and allow the patient to select one that is
    convenient.

Although not all clinics have a future open schedule, and many clinics
do not provide options to the patient, allowing the patient to select an
appointment is preferred because it encourages participation and
endorsement from the patient.

-   The clerk will enter the patient's name or chart number into the
    requested opening.

-   If the patient is physically present, the clerk will print the
    patient an appointment slip confirming the date and time of the
    appointment. If the appointment is being handled by mail, a copy of
    the appointment slip will be mailed to the patient.

## Exceptions to the Standard Scheduling Process

  -----------------------------------------------------------------------
  If . . .                        Then . . .
  ------------------------------- ---------------------------------------
  the clinic cannot locate a      The clerk should contact Patient
  chart number for the patient,   Registration to check for an inactive
                                  record or a temporary medical record
                                  number.

  a patient is being asked to     The chart should be with the
  return to the clinic within the appointment charts. The appointment
  next two work days,             should be entered into the computer.

  the patient has never been to   The patient should be advised to come
  the facility before,            to the clinic one hour before the
                                  scheduled time of the appointment with
                                  the required documents, to have a chart
                                  prepared.

  during the appointment process, The chart will be reactivated in the
  the clerk is advised that the   RPMS **Patient Registration** menu, if
  patient's chart is inactive and the patient is physically present at
  stored at the Federal Record    the time the appointment is made.
  Center (FRC),                   

  the patient is not present,     The patient will be advised to come one
                                  hour early for the appointment. The
                                  patient should be directed to
                                  Registration and inform Patient
                                  Registration that their chart is
                                  inactive.

  the physician needs the         The chart can be retrieved from the
  inactive record,                Federal Record Center, based on rules
                                  of your local archive center.
  -----------------------------------------------------------------------

## Preventing "Did Not Keep Appointments" (DNKA) 

Although some missed appointments are unavoidable due to a lack of
dependable transportation, telephones, or inclement weather, "Did Not
Keep Appointment" (DNKA) is a major cause of inefficiency in clinic
operations.

Suggestions to reduce DNKAs include:

-   Offering the patient a selection of times when the appointment is
    made initially.

-   Encouraging the patient to call to make a change in their
    appointment, if events make it impractical to attend. It is easier
    to reschedule a patient and then schedule a new or walk-in patient
    for that time in the day's schedule.

In addition, a telephone number for the appointment clerk should be
provided to the patient when the appointment is rescheduled. The message
should state:

"If you cannot keep your appointment, please call us at \_\_\_\_\_\_\_
to let us know so we can schedule someone else in that time and give you
a better time."

-   Making a courtesy "appointment reminder" telephone call one day
    prior to the scheduled appointment.

-   Establishing a system for reviewing charts of patients who did not
    keep their appointments for that day. The person responsible for
    reviewing the charts may be the provider or nurse with whom the
    patient had the appointment.

Although the appointment clerk has a role in preparing the paperwork,
making appointments, and following up on decisions, the actual decision
as to what action is to be taken rests with the professional staff
member. The provider may decide to:

-   Take no action and have the patient return at an unspecified future
    time.

-   Schedule a new appointment with a reminder notice to the patient of
    the date and time.

-   Refer a Public Health Nurse or Community health Representative to
    check on the status of the patient.

-   Initiate a verbal dialogue with the patient.

A notation should be placed in the medical record or a note should be
entered into the Electronic Health Record (EHR), that the patient did
not keep their appointment. This should be signed by the provider or
nurse.