Why patients should arrive late: The impact of arrival time on patient satisfaction in an academic clinic

Medway, Allen; Riese, Werner de; Riese, Cornelia S. de; Cordero, Joehassin

doi:10.1016/j.hjdsi.2015.09.002

Cited by 16 publications

(15 citation statements)

References 6 publications

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“…This included not only reduced overall satisfaction, but also worse perceptions of information, instructions, and the overall treatment provided by various clinicians [ 2 ]. Interestingly, a different study suggested that patients who arrive late have higher satisfaction due to shorter wait times [ 24 ]. Future work should focus on whether and how the patient experience is impacted by prolonged wait times related to early arrival to outpatient clinic.…”

Section: Discussionmentioning

confidence: 99%

Discordance between 'actual' and 'scheduled' check-in times at a heart failure clinic

et al. 2017

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IntroductionA 2015 Institute Of Medicine statement “Transforming Health Care Scheduling and Access: Getting to Now”, has increased concerns regarding patient wait times. Although waiting times have been widely studied, little attention has been paid to the role of patient arrival times as a component of this phenomenon. To this end, we investigated patterns of patient arrival at scheduled ambulatory heart failure (HF) clinic appointments and studied its predictors. We hypothesized that patients are more likely to arrive later than scheduled, with progressively later arrivals later in the day.Methods and resultsUsing a business intelligence database we identified 6,194 unique patients that visited the Cleveland Clinic Main Campus HF clinic between January, 2015 and January, 2017. This clinic served both as a tertiary referral center and a community HF clinic. Transplant and left ventricular assist device (LVAD) visits were excluded. Punctuality was defined as the difference between ‘actual’ and ‘scheduled’ check-in times, whereby negative values (i.e., early punctuality) were patients who checked-in early. Contrary to our hypothesis, we found that patients checked-in late only a minority of the time (38% of visits). Additionally, examining punctuality by appointment hour slot we found that patients scheduled after 8AM had progressively earlier check-in times as the day progressed (P < .001 for trend). In both a Random Forest-Regression framework and linear regression models the most important risk-adjusted predictors of early punctuality were: later in the day appointment hour slot, patient having previously been to the hospital, age in the early 70s, and white race.ConclusionsPatients attending a mixed population ambulatory HF clinic check-in earlier than scheduled times, with progressive discrepant intervals throughout the day. This finding may have significant implications for provider utilization and resource planning in order to maximize clinic efficiency. The impact of elective early arrival on patient’s perceived wait times requires further study.

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Section: Discussionmentioning

confidence: 99%

Discordance between 'actual' and 'scheduled' check-in times at a heart failure clinic

et al. 2017

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“…10 Oftentimes, patients who arrive late have a shorter wait time and are significantly more satisfied with their visit. 11 In consequence, patients who arrive on time but have a long wait before being seen by the provider could consciously or subconsciously arrive later for their subsequent appointments in an attempt to decrease the amount of time they wait for the provider.…”

Section: Introductionmentioning

confidence: 99%

Patient- and Visit-Level Variables Associated With Late Arrival to Pediatric Clinic Appointments

Hang

Lich

Kelly

et al. 2016

Clin Pediatr (Phila)

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We conducted a cross-sectional study to evaluate timeliness of patient arrival at a pediatric multispecialty clinic. Bivariate and ordered logistic regression analyses were conducted to determine the odds of late arrival by specified patient- and visit-level characteristics. A total of 64 856 visits were available for analysis, of which 6513 (10.0%) were late arrivals. The odds of late arrival were higher for patients who spoke English (odds ratio [OR] = 1.34, P < .001) compared with those who spoke Spanish, had Medicaid (OR = 1.54, P < .001) or no insurance (OR = 1.49, P < .001) compared with those with insurance other than Medicaid, and were late to their previous visit (OR = 2.46, P < .001). Visit-level variables associated with late arrival included appointment time earlier in the day (i.e. 8-10 am, OR = 2.77, P < .001 compared with 4-6 pm), earlier in the week (i.e. on Mondays, OR = 1.21, P < .001 compared with Wednesdays), and for certain subspecialty clinics ( P < .001). Numerous variables are significantly associated with late arrival for pediatric clinic appointments.

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“…33 Logistics include scheduling the visit, the convenience of the location and parking, paperwork, and waiting time in between interactions-the last of which is parameterized in this study as overall cycle time, waiting-room time, and in-room time. 13,36…”

Section: Integrated Model Of Patient Satisfactionmentioning

confidence: 99%

“…This has been demonstrated both in other spine practices and in specialties outside of spine surgery. 12,27,31,[35][36][37] This is important because overall satisfaction has been shown to influence downstream patient behavior: patients who are less satisfied are less likely to schedule follow-up clinic visits, more likely to use emergency services, and less likely to adhere to medications and treatment recommendations. 4,22,37 So how do we improve wait times and the perception thereof?…”

Section: Interpretation Of Findingsmentioning

confidence: 99%

The true penalty of the waiting room: the role of wait time in patient satisfaction in a busy spine practice

Zakare-Fagbamila

Park

Dickson

et al. 2020

Journal of Neurosurgery: Spine

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OBJECTIVEMost clinics collect routine data on performance metrics on physicians for outpatient visits. However, the relationship of these metrics with patient experience is unclear. The goal of this study was to investigate the relationships between the Consumer Assessment of Healthcare Providers and Systems Clinician and Group Survey (CG-CAHPS), the standard patient experience survey, and clinic performance metrics to understand the determinants of patient satisfaction and identify targets for improving patient experience.METHODSThe authors performed a retrospective single-institution cohort review of spine surgeon metrics over 15 months including demographics, waiting-room times, in-room times, lead times, timely note closure, timely MyChart responses, and monthly patient volume. Kruskal-Wallis tests and mixed-model regression were used to determine the predictors of 3 domains of patient satisfaction—Global, Access, and Communication.RESULTSOver 15 months, 22 surgeons conducted 27,090 visits. The average clinic visit total time was 85.17 ± 25.75 minutes. Increased wait times were associated with poor Global (p = 0.008), Access (p < 0.001), and Communication scores (p = 0.003) in univariate analysis. Every 10-minute increase in waiting time was associated with a 3%, 9.8%, and 2.4% decrease in Global, Access, and Communication scores, respectively. Increased in-room time was also an independent predictor of poor Access scores (p < 0.001). In multivariate analysis, increased wait times were negative predictors of Global (p = 0.005), Access (p < 0.001), and Communication (p = 0.002) scores.CONCLUSIONSExcessive waiting-room time significantly impacts unexpected dimensions of the patient experience and impacts communication with patients. Understanding the complex relationship between the factors that inform the patient experience will help target effective interventions to improve clinic efficiency and patient satisfaction.

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Why patients should arrive late: The impact of arrival time on patient satisfaction in an academic clinic

Cited by 16 publications

References 6 publications

Discordance between 'actual' and 'scheduled' check-in times at a heart failure clinic

Discordance between 'actual' and 'scheduled' check-in times at a heart failure clinic

Patient- and Visit-Level Variables Associated With Late Arrival to Pediatric Clinic Appointments

The true penalty of the waiting room: the role of wait time in patient satisfaction in a busy spine practice

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