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Wednesday, December 9, 2009

The advent of the 'QuickSick' visit

One day in early 2004, I was trying to schedule myself a dental appointment. Scheduling the appointment had been on my to-do list for a week. It was difficult to make enough time for this simple call. Finally, I actually had two minutes to sit down for lunch at 12:58 one busy day in the office. I called the dentist. They were, of course, also at lunch. Their answering service could not schedule my appointment. Since their office hours were the same as mine, but their lunch hour was twice as long as mine, I was thinking I needed a new dentist. Then it suddenly dawned on me: My patients were having this same experience when they called my office for an appointment. We needed to do something about this.

Immediately, we got an informal meeting together with staff. We decided that my nurse and I would stagger our lunch with the other physicians and their nurses, so that our office would never “close” during the middle of the day. While we were open, we would never roll phones to the answering service, which could neither schedule visits nor answer questions. We have done this ever since.

At the time, we were having a horrible time accommodating the predictable swell in demand for acute sick visits during the winter cold and flu season. We were not quite ready to hire another partner, but wanted to be able to handle this seasonal variation in demand somehow. Eventually, after consulting management literature and not finding a good solution, we came up with what we've trademarked as the QuickSick visit.

Basically, a QuickSick is a focused office visit dealing with the essentials of a single, upper respiratory problem; it's billed as a 99213. The visit can take as little as 5 minutes. We built a template in our EMR (Centricity) that includes a check-box history, which the nurse completes along with obtaining vital signs. Next is a check-box physical, which the physician completes after reviewing and adding to the history. Finally, the system produces a printable bill and an assessment and plan form complete with quicktexts and check-box advice for documentation. After all, I pretty much tell patients with strep throat to care for themselves in exactly the same way every time.

When a patient calls with a problem that might be appropriate for a QuickSick, the receptionist follows a set script for arranging the appointment.

QuickSickTM scheduling: sample script
October 12, 2005, updated 1/2/08

Patient calls, requesting same-day/next-day appt.

  1. Get name, age (no one over 65 yrs of age), established patient.
  2. Get symptoms; must be upper respiratory (e.g., congestion, eye, sore throat, cough, fever)
  3. Ask if they would like a QuickSickTM visit – a 5-minute visit designed with their busy schedule in mind – to take care of this illness only.
  4. If, so, schedule in designated QS spots same-day or next day
  5. Remind them that they need to be on time, since as many as 12 ill people may be seen over the noon (or applicable) hour and we want everyone to be able to be back to work on time. Remind them to bring their insurance information/payment method.

On arrival for a QuickSick, the patient is given a copy of an explanatory letter. We have received tremendous positive feedback on this service. Patients now call and ask for a QuickSick visit by name. My partners all use them. We were even written up in the New York Times a few years back for the concept.

We all love the concept of these visits. We typically allot 3 per 15 minute time slot around the noon hour. I do mine between noon and 1, while my partners take 11 to noon and 1 to 2, respectively, and we all do them at 4:30. This matches up beautifully with patient needs. Working patients can run in and out in 30 minutes or less. Children who become ill during the day at school can always be seen the same day. Most days we do not book all of these visits (we could see 15 of them in a day, theoretically), but as long as we book at least 5 (and we always do that), we are not losing any spaces.

We feel this type of visit offers the busy “consumer-minded” patient an alternative to retail and acute clinics. They are still seen in their medical home, in the context of their whole person and with their medical history. This comes in handy for more complex cases, like the time a QuickSick patient with strep throat also happened to be in new-onset atrial fibrillation with a rapid ventricular response. She was easily transported by ambulance to the hospital, and I went right along with the rest of my QuickSicks.

The QuickSicks also ended up being an excellent infection control measure, quite by accident. With so many flexible appointment slots open per day, the “sick” patients tend to cluster together in the waiting room. The rest of the day, the waiting room is full of “non-sick” patients.

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About the Author

Melissa Gerdes, MD, is a family physician practicing at Methodist Family Health Center – South Arlington in Arlington, Texas, and former president of the Texas Academy of Family Physicians.

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