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Study objective This study mainly aimed to identify the effect of waiting times on patient satisfaction. Methods A clever questionnaire was designed, and it contained two parts. The first part includes a series of short, standardized questions about expected waiting time (EWT), reasonable waiting time (RWT), limited waiting time (LWT), and basic personal information. This part of the questionnaire was filled in when the patient entered the waiting area. The second part includes perceived waiting time (PWT) and satisfaction evaluation, and this part was filled before patients entered the doctor’s office. The two questionnaires were summarized by the same number. The actual waiting time (AWT) was calculated based on the time difference between the registration time recorded by the experimenter and the time between entering the clinic. Linear regression was used to analyze the influence of waiting times on satisfaction. Before starting data collection, this study was approved by the hospital health ethics committee. Results A total of 323 questionnaires were collected, in which 292 (90.4%) were valid. EWT, LWT, RWT, and PWT had a significant effect on patient’s satisfaction (p = 0.006, p = 0.043, p = 0.009, p = 0.000), whereas AWT had no significant effect on satisfaction (p = 0.365). The difference between EWT and AWT had a significant effect on satisfaction (p = 0.000), while the difference between PWT and AWT had a significant effect on satisfaction (p = 0.000). Age, education background, gender, appointment, and hospital visit experience had no significant effect on patient satisfaction (p = 0.105, p = 0.443, p = 0.260, p = 0.352, p = 0.461). Conclusions The patient’s satisfaction of waiting time was not directly affected by the AWT, but by the subjective waiting times. And the difference between AWT and EWT has a significant impact on patient’s satisfaction. Meanwhile, the difference between AWT and PWT also has a significant impact on patient’s satisfaction. Therefore, service quality can be improved by hospital managers by focusing on the adjustment of patients’ subjective waiting time while reducing the objective waiting time.

Background Long waiting time in hospital leads to patients’ low satisfaction. In addition to reducing the actual waiting time (AWT), we can also improve satisfaction by adjusting the expected waiting time (EWT). Then, what degree should medical institutions adjust patients' EWT to in order to improve patient’s satisfaction more effectively? Methods A total of 303 patients who were treated by the same doctor from August 2021 to April 2022 voluntarily participated in this study. The patients were randomly divided into six groups: a control group (n = 45) and five experimental groups (n = 252). Each group answered different questionnaires to explore the impact of different degrees of EWT extension on patient’s satisfaction. Each participant only participated in filling out one questionnaire. 297 valid questionnaires were obtained from the 303 questionnaires given. Results The experimental groups had significant differences between the initial EWT (T0) and extended EWT (T1) under the effect of unfavorable information (20.0 [10.0, 30.0] vs. 30.0 [10.0, 50.0], Z = -4.086, P < 0.001). There was no significant difference between sex, age, education level and hospital visit history (χ2 = 3.198, P = 0.270; χ2 = 2.177, P = 0.903; χ2 = 3.988, P = 0.678; χ2 = 3.979, P = 0.264) in extended EWT (T1). Compared with the control group, significant differences were found in patient’s satisfaction when T1 = 80 min (χ2 = 13.511, P = 0.004), T1 = 90 min (χ2 = 12.207, P = 0.007) and T1 = 100 min (χ2 = 12.941, P = 0.005). However, no significant difference was found when T1 = 70 min (χ2 = 7.747, P = 0.052) and T1 = 110 min (χ2 = 4.382, P = 0.223). When T1 = 90 min (T1 = Ta), 69.4% (34/49) of the individuals felt “very satisfied”. This proportion is not only significantly higher than that of the control group (34/ 49 vs. 19/52, χ2 = 10.916, P = 0.001), but also the highest among all groups. Conclusions Providing unfavorable information prompts can extend the EWT, but the extension needs to be based on the actual number of patients. Only when the extended EWT is close to the AWT can the patients’ satisfaction level be remarkably improved. Therefore, medical institutions can adjust the EWT of patient’s through information release according to the AWT of hospitals to improve patient’s satisfaction.

Background Hormonal reproductive factors have been suggested to play an important role in the etiology of rheumatoid arthritis (RA), an autoimmune inflammatory disorder affecting primarily women. We conducted a two-sample Mendelian randomization (MR) study examining three relevant exposures, age at menarche (AAM), age at natural menopause (ANM) and age at first birth (AFB), with the risk of RA.Methods We collected summary statistics from the hitherto largest GWAS conducted in AAM (N=329,345), ANM (N=69,360), AFB (N=251,151) and RA (Ncase=14,361 and Ncontrol=43,923), all of European ancestry. We constructed strong instruments using hundreds of exposure-associated genetic variants and estimated causal relationship through different MR approaches including an inverse-variance weighted method, an MR-Egger regression and a weighted-median method. We conducted a multivariable MR to control for pleiotropic effect acting in particular through obesity and socioeconomic status. We also performed important sensitivity analyses to verify model assumptions.Results We did not find any evidence in support for a causal association between genetically predicted reproductive factors and risk of RA (ORAAM=1.06 [0.98-1.15], ORANM=1.05 [0.98-1.11], ORAFB=0.85 [0.65-1.10]). Results remained consistent after removing palindromic SNPs (ORAAM=1.06 [0.97-1.15], ORANM=1.05 [0.98-1.13], ORAFB=0.81 [0.61-1.07]) or excluding SNPs associated with potential confounding traits (ORAAM=1.03 [0.94-1.12], ORANM=1.04 [0.95-1.14]). No outlying instrument was identified through the leave-one-out analysis.Conclusions Our MR study does not convincingly support a casual effect of reproductive factors, as reflected by age at menarche, age at menopause and age at first birth, on the development of RA. Despite the largely augmented set of instruments we used, these instruments only explained a modest proportion of phenotypic variance of exposures. Our knowledge regarding this topic is still insufficient and future studies with larger sample size should be designed to replicate or dispute our findings.