clinical-outpatient/SOPs/Patient-Care/SOP-OPT-001-Appointment-Management.md

# Standard Operating Procedure: Outpatient Appointment Management

| Document ID | SOP-OPT-001 |
|-------------|-------------|
| Title | Outpatient Appointment Scheduling and Management |
| Revision | 1.0 |
| Effective Date | [DATE] |
| Author | [AUTHOR] |
| Approved By | [APPROVER] |
| Department | Outpatient Services |

---

## 1. Purpose

To establish standardized procedures for scheduling, managing, and documenting outpatient appointments to ensure efficient clinic operations, optimize provider schedules, and enhance patient access to care.

## 2. Scope

This procedure applies to all outpatient appointment scheduling including:
- New patient appointments
- Follow-up appointments
- Procedure appointments
- Telehealth visits
- Same-day/urgent appointments
- Specialist referrals

## 3. Responsibilities

### 3.1 Scheduling Staff
- Schedule appointments per protocols
- Verify insurance and authorizations
- Communicate appointment details to patients
- Manage appointment reminders

### 3.2 Front Desk Staff
- Complete patient check-in/check-out
- Collect copays and outstanding balances
- Update patient demographics
- Schedule follow-up appointments

### 3.3 Clinical Staff
- Prepare patients for encounters
- Document clinical information
- Communicate provider schedules

### 3.4 Providers
- Adhere to schedule templates
- Communicate scheduling preferences
- Approve schedule modifications

## 4. Definitions

| Term | Definition |
|------|------------|
| New Patient | Patient not seen by practice within past 3 years |
| Established Patient | Patient seen within past 3 years |
| Slot | Designated time block for specific appointment type |
| Template | Schedule structure defining available appointment types |
| No-Show | Patient who fails to appear for scheduled appointment |

## 5. Procedure

### 5.1 Appointment Scheduling

#### 5.1.1 Information to Collect
| Required Information | Check |
|---------------------|-------|
| Patient full legal name | ☐ |
| Date of birth | ☐ |
| Contact phone number(s) | ☐ |
| Email address (optional) | ☐ |
| Insurance information | ☐ |
| Referring provider (if applicable) | ☐ |
| Reason for visit | ☐ |
| Preferred appointment times | ☐ |

#### 5.1.2 Appointment Type Selection

| Appointment Type | Duration | Notes |
|-----------------|----------|-------|
| New Patient Comprehensive | 60 min | Full history and physical |
| New Patient Focused | 30-45 min | Single concern |
| Established Patient Follow-up | 15-20 min | Routine follow-up |
| Established Patient Extended | 30-40 min | Complex issues |
| Procedure | Varies | Per procedure type |
| Telehealth | 15-30 min | Virtual visit |
| Same-Day/Urgent | 15-20 min | Acute concerns |

#### 5.1.3 Scheduling Process
1. **Verify Patient Status**
   - New vs. established patient
   - Check for alerts or special needs
   - Review last visit date

2. **Match Appointment Type**
   - Assess reason for visit
   - Select appropriate appointment type
   - Confirm duration adequate for needs

3. **Find Available Slot**
   - Check provider availability
   - Offer multiple date/time options
   - Consider patient preferences

4. **Complete Booking**
   - Confirm appointment details
   - Verify contact information
   - Document special requests

5. **Provide Appointment Information**
   - Appointment date and time
   - Location and parking information
   - Pre-appointment instructions
   - What to bring (insurance, ID, referral, etc.)
   - Cancellation policy

### 5.2 Appointment Reminders

| Reminder Type | Timing | Method |
|--------------|--------|--------|
| Initial confirmation | At scheduling | Verbal + written |
| First reminder | 7 days prior | Automated call/text/email |
| Second reminder | 2-3 days prior | Automated call/text/email |
| Final reminder | 1 day prior | Automated call/text/email |

### 5.3 Check-In Process

1. **Patient Arrival**
   - Greet patient professionally
   - Verify identity (photo ID)
   - Confirm appointment details

2. **Registration Update**
   - Review and update demographics
   - Verify insurance information
   - Collect copies of cards if changed
   - Verify emergency contact

3. **Documentation Collection**
   - Obtain referral authorization (if required)
   - Collect completed forms
   - Obtain signatures as needed

4. **Financial**
   - Verify insurance eligibility
   - Collect copay
   - Discuss outstanding balances
   - Arrange payment plans if needed

5. **Clinical Handoff**
   - Note patient arrival in system
   - Alert clinical staff
   - Provide estimated wait time if delayed

### 5.4 Check-Out Process

1. **Schedule Follow-up**
   - Review provider orders for follow-up timing
   - Offer appointment options
   - Provide written confirmation

2. **Orders and Referrals**
   - Provide lab/imaging orders
   - Explain referral process
   - Schedule procedures as indicated

3. **Financial Close**
   - Collect any additional payments
   - Provide receipts
   - Explain billing process

4. **Patient Materials**
   - After visit summary
   - Educational materials
   - Prescription information

### 5.5 No-Show Management

1. **Same-Day Follow-up**
   - Attempt to contact patient
   - Document contact attempts
   - Offer rescheduling

2. **Documentation**
   - Mark appointment as no-show
   - Document reason if known
   - Note rescheduling attempts

3. **Pattern Identification**
   - Track chronic no-shows
   - Implement interventions:
     - Phone reminders
     - Require confirmation
     - Consider scheduling policies

4. **Clinical Considerations**
   - Flag urgent clinical needs
   - Notify provider if clinically significant
   - Send follow-up communication per policy

### 5.6 Cancellations and Rescheduling

#### Patient-Initiated
1. Document reason for cancellation
2. Offer alternative dates
3. Update appointment status
4. Fill vacated slot if possible

#### Provider-Initiated
1. Notify affected patients promptly
2. Offer alternative dates/providers
3. Document reason
4. Prioritize by clinical urgency

### 5.7 Wait List Management

1. **Add to Wait List**
   - Earlier date desired
   - Specific provider requested
   - Urgent clinical need

2. **Work Wait List**
   - Check daily for openings
   - Contact patients in priority order
   - Update list status

## 6. Special Situations

### 6.1 Same-Day Appointments
- Reserve slots for urgent needs
- Assess acuity to determine appropriateness
- Document medical necessity

### 6.2 Telehealth Appointments
- Verify technology capability
- Provide access instructions
- Confirm consent for telehealth
- Test connection before appointment

### 6.3 Interpreter Services
- Identify language needs at scheduling
- Arrange interpreter services in advance
- Allow additional appointment time
- Document interpreter used

## 7. Documentation

- FRM-OPT-001 New Patient Registration
- FRM-OPT-002 Insurance Verification
- Appointment confirmation letter/text
- Check-in/check-out log

## 8. Quality Metrics

| Metric | Target |
|--------|--------|
| Schedule utilization | >85% |
| No-show rate | <10% |
| Same-day cancellation rate | <5% |
| Wait time to appointment (new patients) | Per specialty benchmark |
| Patient satisfaction with scheduling | >90% |

## 9. References

- Practice management policies
- Insurance contract requirements
- State and federal regulations

---

## Revision History

| Rev | Date | Description | Author |
|-----|------|-------------|--------|
| 1.0 | [DATE] | Initial release | [AUTHOR] |