Abstract
So far we have been operating traditionally at our clinic under the principle: “first come first served” and due to the small size of our team, we automatically placed a new patient on a waiting list. During that time our secretary could write to obtain the necessary information concerning the waiting cases. For several years, we noticed that more than half of the waiting people no longer needed us when we were ready and able to look after them. Very puzzled by this, we decided to examine this phenomenon more closely.
We reviewed much of the literature on the subject without finding a readily applicable solution. We analysed our intake procedure more closely and made a retrospective study of a group who dropped out before the evaluation was completed. We then tried a new intake system by which the patient was seen almost immediately but very very briefly. We made a lot of these brief evaluations. With this procedure, we got rid of our waiting list.
In 15 to 20 percent of the cases, we could help these people find a solution and they did not require any further attention. As for the others, the necessary information was gathered much faster, the paper work was reduced and the children were better prepared for the evaluation. We could also check the urgency of the requests. The anxious parents no longer needed to phone the secretary again and again.
To further improve this system, a central appointment office equipped with a computer would help the patients and the personnel. The clinic must be geographically accessible. Patient-representatives could help usher some of our patients through our labyrinthine hospital.
As for broken appointments, we noticed that people who insisted on an immediate appointment very often did not show up if we offered to see them right away. We observed that the “non-shows” have often been more or less forced to come by the referring person who wished for this consultation much more than the patient himself. A postcard to contact a “non-show” remains a good method. To fill the vacuum left by a “non-show”, we keep one or two families on stand by for a few weeks and call them in when we have such a gap; it works well if this arrangement is adequately made with a family who lives nearby.
It is not easy to forecast who will continue to a final evaluation and treatment if we do not examine the relation between the referring person and his patient. If the referring person does not take the necessary time to prepare the patient but pushes him toward child psychiatry, chances are that this patient might not pursue.
We believe this new system advantageous enough to adopt it permanently.