practice management

Strategies to Manage High Patient Volumes

High visit volumes can strain physicians and staff and pile on wait times and frustration for families. Pediatricians who run an efficient practice can help their teams and their patients feel more satisfied with this busy period, and can depend on the key skills they already have, like delegation and practice workflow management, to deal with the surge in patients. With advice from pediatricians who have endured and thrived the wave, here are strategies for both accommodating high patient volumes and getting kids the preventative care that they need.

What Causes High Visit Volumes in Pediatric Care?

Over the course of a typical year, an independent pediatric practice is accustomed to the peaks and valleys of patient visit volume. According to PCC’s Chip Hart, these usually align with key events in a child’s year -- a physician can reasonably expect a slower period during holidays and the summer months, with peaks during winter’s flu season and during autumn when kids are preparing for a new school year.

In a previous post, we discussed the reasons why pediatricians are experiencing higher than normal patient visit volumes in the latter half of 2021. Due to the COVID-19 pandemic, practices across the country have experienced marked fluctuations in patient visit volume, including low volumes in the winters of 2019 and 2020 and high volumes upon kids’ return to school in late summer of 2021. 

These kinds of shifts are alarming for population health and for practice revenue cycles too, as unexpected changes in cash flow can pose difficulties in paying bills and planning ahead. Additionally, low visit volume could indicate that children in need of wellness visits and routine vaccinations are veering off schedule, while high volumes are stressful for staff and can decrease patient satisfaction as wait times increase and physicians have less time to spend with each family. 

Surges in volume due to the pandemic display a critical need for efficient handling of acute cases while providing the standard well care children need to remain healthy. The American Academy of Pediatrics (AAP) “strongly supports the uninterrupted care of children during the COVID-19 pandemic to ensure timely access and optimal care outcomes”. 

Addressing Patient Surges with Practice Management Tools

The following strategies from the AAP can help your practice run efficiently, communicate well, and continue to provide exceptional care for children while paring down on what is superfluous.

Practice management strategy will help managing physicians and office managers get a handle on the broad scope of workflows and major pain points. It also enables them to identify gaps in their system. First on the list is the safety of all staff and visitors to the practice, which requires planning for PPE, social distancing, and more.

Staff and Patient Safety and OSHA ETS Rules

The AAP recommends the use of personal protective equipment (PPE) for healthcare workers and patients. A practice’s set up will depend on local resources, epidemiology, and staffing resources, but should include:

  • Written COVID-19 protocol plans
  • Hygiene procedures
  • Distancing protocols
  • Use and training for PPE, including respirators
  • Requirements for maintaining 6 feet distancing where possible

These standards are required under Occupational Safety and Health Administration’s (OSHA) Emergency Temporary Standard Rules, which apply to all healthcare locations that admit patients who may be infected with COVID-19. You can learn more about the OSHA Emergency Temporary Standard Rules in our previous post.

Additional safety and general wellness procedures endorsed by the AAP include vaccination for all staff, screening all patients for COVID-19 symptoms, and supporting the mental health of physicians and staff.

Logistics and Materials for High Patient Volumes

Where possible, it’s a good idea to plan to order and store materials such as PPE, vaccines, disposable masks, and many more materials ahead of when they are actually needed. Sourcing and storing these materials will depend on the available resources your practice has financially and physically.

The CDC has a resource for optimizing current stores of PPE, including gloves, face shields, gowns, and more. If your practice is experiencing difficulty sourcing supplies from your usual suppliers, pediatricians have sometimes found success simply by inquiring of their colleagues. PCC clients can use PCC Community for such discussions. All independent pediatricians can find helpful advice and resources from the AAP’s Section on Practice Management and Administration (SOAPM) -- you can find information about SOAPM from PCC’s Chip Hart on his blog.

Strategies for Patient Surges

High volumes of patients require that a practice operate with as much efficiency as possible while carefully considering the capacity of their space, material resources, and staff capabilities. Some strategies your practice can consider include telehealth and delegation of certain tasks.


Telehealth appointments for non-acute cases can decrease the number of patients in the office at a time, support the care of chronic conditions such as ADHD and behavioral health, all while supporting the needs of families whose access to the physical office is limited.

Benefits of telehealth include reduced waiting times, and great turnover since exam rooms do not need to be prepared or sanitized between patients. A great workflow can also get patients through the check-in/check-out process promptly, leaving a maximum of time physicians get to spend with their patients. Pediatricians have also noted that telehealth also offers unique benefits, like the ability to evaluate a child’s home environment and the opportunity to treat a child in the space they feel most comfortable.

Referrals and Delegation

Referrals are an important piece of a larger facet of addressing a patient surge: delegation. A referral system could include choosing to refer patients outside of the practice for services like COVID-19 testing, even if the practice has performed such testing on-site. Delegating such tasks outside of the practice, even temporarily, can help support staff during a busy period. Referrals should also have their own workflow; PCC EHR users can nominate a Referral Coordinator to handle referrals for best results.

Referrals can be formal, recorded within the EHR, or informal -- listed as a resource on your practice website to inform patients. This method works best if you have the proper relationship with a referring provider or location, such as the local hospital, who agrees to see your practice’s patients. This could included the added benefit of easier documentation exchange between locations.

Efficient Patient Workflows

Efficient workflows are a must for practices so that staff can focus on patients instead of tasks -- the key is making note of where staff or patients get stuck, frustrated, or confused and address these pain points. In addition to those like referrals we’ve just mentioned, efficient telemedicine, appointment scheduling, triage, and check in/check out workflows can all help your practice serve patients quickly and simply. You might add items for accuracy, like a checkpoint so that nurses document vaccinations accurately, or delegate notation to a scribe or experienced staff member to reduce after-hours charting.

Healthcare Communication Tools

During high patient volumes, you might consider altering certain workflows to accommodate, such as referring all patient appointment, documentation, or payment requests to the patient portal. If patients have to reach the office, be sure to update your phone system. Using a VoIP (Voice over IP) such as GoToConnect or Nextiva, you can create a “phone tree” to direct patients to services like the front desk, billing, and administration, as well as configure queues to max out at a certain number of callers -- this helps keep queues manageable for staff on the phones while keeping up ongoing positive communication with families. 

You may have noticed that communication is the thread that ties many of these strategies for handling high patient volumes together. Communication around reasonable expectations for staff, physicians, and families can help your practice community work efficiently, provide the essential preventative care patients need, as well as address the acute care that is required in these unprecedented times. Part of excellent communication is identifying where your practice needs some help, and beginning from there.

If your practice needs some help to provide children with the behavioral and mental health resources they need, have you considered integrating behavioral healthcare right into your practice? Learn how to integrate this crucial healthcare into your current workflows at any budget with our ebook.

Integrating Behavioral Health:  A Guide to Expanding Access

Allie Squires

Allie Squires is PCC's Marketing Content Writer and editor of The Independent Pediatrician. She holds a master's in Professional Writing from NYU.