If your clinic has too many patents, there are two common causes that help create this: 1) there are too many new intakes, and 2) patients in the clinic are not moving through the system efficiently. This page will cover this second situation, discussing how to identify the cases that are not progressing and giving practical advice on addressing this population.
If providers have too many mild cases or cases that are not showing any signs of progress, it will lead to caseloads growing, which increases wait times for follow-ups. Note that this will further contribute to slow progress, as patients seen every 2-3 weeks will have slower recoveries. Because individual therapy slots are a valuable commodity, they should be used on cases that actually need them and will show a clinical benefit. An excellent starting point for this topic is to review the Managing Patient Throughput training deck, which covers best practices for managing how patients move through a clinic’s system.
Benefits: improving patient flow is beneficial to clinics in several ways:
- Make it easier to meet the Access to Care standards for intakes within the clinic
- Can reduce wait times for follow-ups, leading to shorter treatment courses and improved outcomes
- Reduce burnout for providers by decreasing number of cases who do not improve
Responses from Needs Assessment Survey:
Question 4.1: “What are the primary factor(s) that contribute to the long wait times?
B) Some provider caseloads have too many mild cases or have cases not making progress
The Managing Patient Throughput training deck covers how to identify the cases who are mild or not progressing, and covers practical strategies to address this population. This includes a review of toolkit items that you can use to make this process easier. A key step in this process is to utilize clinic appointment data to identify patients that are high utilizers of services, as described in the handout Analyzing Clinic Appointment Data. Two particular types of high utilizers are subclinical cases (patients who are no longer clinically symptomatic, but who continue in treatment) and cases that have been in care for some time with no progress. There is a template for an SOP/OI for Managing Subclinical Patients you can modify and use to set a policy on how the clinic addresses these types of cases. You can share the handout on Best Practices for Changing Levels of Care with providers, giving them templates for handling difficult conversations with patients. Detailed information about using treatment team meetings to assist with shifting patients to a more appropriate level of care can be found here.
The deck also covers how the clinic can transfer existing long-term therapy patients into process groups, allowing them to receive ongoing care while opening up individual therapy slots. More information on establishing a group therapy program within the clinic can be found here.
C) We have a large proportion of patients who mainly want a military discharge and fill up therapy slots
If your clinic has a large population of active-duty members who are entering care within the clinic in order to obtain a separation from the military, this can be problematic in several ways. First, this population is known for not making clinical progress, urgent walk-in appointments and frequent hospitalizations. This can be a drain on personnel morale and resources. This information is reviewed in the Managing Patient Throughput deck.
We recommend that providers make attempts to retain service members who are appropriate for retention, but that for those patients who are adamant about separation, establish a track to manage them. We have a brief Patient Treatment Expectations and Beliefs Scale you can add to your intake paperwork that helps identify patients seeking separation. Once it’s determined that the service members will be separated, we recommend setting up specialized groups to provide ongoing weekly treatment (for administrative separations and MEBs). Another best practice is to assign one or more behavioral health technicians (BHTs) to assist with this population, where they perform a case manager role for these patients, ensuring regular check-ins, that paperwork for separations is moving along, and worsening of symptoms is identified early. This can dramatically reduce the workload for providers within the clinic.
Relevant Toolkit Items:
| Item Name | Description | Audience |
|---|---|---|
| Managing Patient Throughput training deck | Training presentation on how to manage patients from referral source, through treatment and termination. Offers strategies for dealing with inappropriate referrals and patients who desire ongoing therapy when it is no longer clinically indicated | Clinic Managers |
| Analyzing Clinic Appointment Data | Handout to guide clinic staff to use clinic appointment data to analyze appointment volume and distribution, workload by provider, group utilization, intakes, common diagnoses, and patients who are high utilizers of clinic resources. | Clinic Managers |
| Best Practices for Changing Levels of Care | Example scripts and templates for changing the treatment plan of a patient who may not wish for/understand the need for change | Providers |
| Patient Treatment Expectations and Beliefs Scale | Scale to solicit patient’s initial reason for seeking treatment and desire for improvement | Providers |
| SOP/OI for Managing Subclinical Patients | Template for clinic managers to use in order to ensure providers set treatment expectations and terminate treatment when it is no longer clinically indicated | Providers |
| FAQs: Therapy Continuation Groups | Handout that answers frequently asked questions regarding therapy continuation groups including session structure, topics, and treatment duration. | Patients |
| Planning for Termination of Treatment | Fact sheet explaining the reasons to plan for termination, how to address with patients, and options for terminating treatment when no longer clinically indicated | Providers |
| Therapy Continuation Groups | Handout that answers frequently asked questions regarding therapy continuation groups including process, format, patient selection, and benefits to the provider, clinic, and patient. | Providers |