Wait Times in Musculoskeletal Patients: What Contributes to Patient Satisfaction

Introduction: The purpose of this study was to determine how wait time duration is associated with patient satisfaction and how appointment characteristics relate to wait time duration and patient satisfaction in the orthopedic surgery clinic. Methods: Two hundred sixty-four patients visiting one of 3 ambulatory orthopedic surgery clinics were asked to estimate their wait time and to rate their satisfaction with the visit. The associations between appointment characteristics, wait time, and satisfaction were analyzed using t tests, 1-way analysis of variance, and Pearson correlation coefficients. Results: Wait times were significantly different based on visit type, appointment time, whether an X-ray was required, and whether a trainee was involved ( P < .001). Patients with wait times less than 30 minutes had higher satisfaction scores ( P < .001). Satisfaction ratings were significantly different based on the surgeon’s management recommendation ( P = .0211), but were not significantly different based on sex, age, office location, visit type, appointment time subsection, or time spent with the physician ( P > .05). Conclusion: Wait times negatively correlated with satisfaction. New patient visits, appointment times in the later third of the day, appointments requiring an X-ray, and appointments involving a trainee had significantly longer wait times. Care should be taken to inform patients with visits involving these characteristics that they may experience longer than average wait times.

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Time stamps used to measure the patient's clinic experience.

Journal of Clinical Oncology ◽

10.1200/jco.2016.34.7_suppl.150 ◽

2016 ◽

Vol 34 (7_suppl) ◽

pp. 150-150 ◽

Cited By ~ 2

Author(s):

Terry Jensen ◽

Roy Brown ◽

Gay Riegel ◽

Lalan S. Wilfong ◽

John Russell Hoverman

Keyword(s):

Patient Satisfaction ◽

Wait Time ◽

Office Visit ◽

Site Quality ◽

Satisfaction Survey ◽

Wait Times ◽

Time Stamp ◽

Patient Satisfaction Survey ◽

Patient Reported ◽

Time Stamps

150 Background: In 2013, a patient reported satisfaction survey indicated 19% of patients waited 20-40 minutes, 8% 40-60 minutes and 4% over 1 hour. We initiated a project to objectively quantify the components of wait times to investigate opportunities for improvement. Methods: Utilizing existing technology in the practice management system, clinic staff use the Day List feature to capture time stamps as patients move through the clinic. We focused on provider appointments but these visits could also include business office, labs, infusion and diagnostics. It was important to define where the wait(s) occurred. The Time Stamp durations measured are as follows: Arrival to Depart – duration of each appointment; Arrival to site to Exam Start – duration of activity until ready to be seen by the provider, includes rooming, labs and business office activity. Used to compare to the patient satisfaction survey responses; Exam Start to Depart – the provider portion of the office visit, includes patient wait plus exam time. Three reports are generated: Time Stamp Error Report indicating the completeness of data collection; Average Wait Times Report with appointment counts by physician by site and average durations; Provider Wait Times Report with office visit counts, Wait Time Category counts ( < 10 min, 10-20, 20-40, 40-60, and > 1 hour ) and average durations. Results: There was a correlation calculation to the patient satisfaction survey of .779, with long wait times more likely to be underreported by patients. Site and physician data were available for review at site Quality Committees. The data can be used by the site to improve processes, such as lab and infusion room scheduling. Time stamps are used to communicate patient readiness for next steps in the office visit. The time stamps provide objective data to discuss patient complaints with staff. Conclusions: Patient wait times are a valued measure of patient satisfaction and quality. Full utilization of the Day List and supporting technology allows us to objectively monitor and improve this aspect of patient care. Table 1: Sample Provider Report [Table: see text]

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The next generation of quality improvement at MSK: Turning chemotherapy process delays into chemo express.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.15_suppl.e18230 ◽

2017 ◽

Vol 35 (15_suppl) ◽

pp. e18230-e18230

Author(s):

Jennifer Tota ◽

Kathleen Levine ◽

Jeanine Gordon ◽

Abigail Baldwin ◽

Jodi Wald ◽

...

Keyword(s):

Quality Improvement ◽

Patient Satisfaction ◽

Patient Experience ◽

Wait Time ◽

Wait Times ◽

Pilot Program ◽

Treatment Results ◽

Average Wait Time ◽

Major Bottleneck ◽

Work Done

e18230 Background: Chemotherapy wait times can dramatically affect patient experience. MSK’s largest outpatient facility has 76 infusion spaces and 250-300 daily visits. A retrospective review of the facility’s infusion area wait times suggested that the lab (where all patients go to get their vitals and blood drawn) was a major bottleneck leading to process delays in infusion. Methods: We conducted a pilot program using a multi-pronged approach. Our goal was to decrease wait time from 40 minutes to an average of 15 minutes. Our initiative was defined as follows: (1) to redefine lab parameters that are relevant for toxicity and to only consider drawing those necessary labs; additionally, we created guidelines for timing of the labs prior to infusion treatment, (2) to introduce a program known as “ChemoExpress” which offers patients the opportunity to get blood work done prior to the day of their infusion appointment. After the labs result, the outpatient RN calls the patient, assesses symptoms and “clears them” for treatment cueing the pharmacy to prepare and “premix” the drug on the day of treatment. Results: 150 patients have enrolled in ChemoExpress. Patient satisfaction was high based on patient satisfaction surveys (n = 20). Average wait time was 9 minutes (76% less) in ChemoExpress participants as compared to an average wait of 39 minutes for those who did not participate in ChemoExpress. Conclusions: Implementing a process that enables patients to have their bloodwork drawn prior to the day of treatment and drugs prepared in advance of their treatment appointment results in greater efficiency in the overall workflow. It also offers the patient a lower wait time and a more efficient and satisfying experience.

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Patient Perspectives on Telemedicine During the COVID-19 Pandemic

Hand ◽

10.1177/15589447211030692 ◽

2021 ◽

pp. 155894472110306

Author(s):

Farhan Ahmad ◽

Robert W. Wysocki ◽

John J. Fernandez ◽

Mark S. Cohen ◽

Xavier C. Simcock

Keyword(s):

Physical Examination ◽

Pain Assessment ◽

Response Rate ◽

Wait Time ◽

Hand Surgery ◽

Wait Times ◽

Online Surveys ◽

Free Response ◽

Likert Scales ◽

Appointment Time

Background Patients received care over telemedicine during the COVID-19 pandemic, and their perspective is useful for hand surgeons. Methods Online surveys were sent October-November 2020 to 497 patients who received telemedicine care. Questions were free-response and multi-item Likert scales asking about telehealth in general, limitations, benefits, comparisons to in-person visits, and opinions on future use. Results The response rate was 26% (n = 130). Prior to the pandemic, 55% had not used telemedicine for hand surgery consultation. Patients liked their telemedicine visit and felt their provider spent enough time with them (means = 9/10). In all, 48% would have preferred in-person visits despite the pandemic, and 69% would prefer in-person visits once the pandemic concludes. While 43% had no concerns with telemedicine, 36% had difficulties explaining their symptoms. Telemedicine was easy to access and navigate (M = 9/10). However, 23% saw telemedicine of limited value due to the need for an in-person visit soon afterward. Of these patients, 46% needed an in-person visit due to inadequate physical examination. Factors that make telemedicine more favorable to patients included convenience, lack of travel, scheduling ease, and time saved. Factors making telemedicine less favorable included need for in-person examination or procedure, pain assessment, and poor connectivity. There was no specific appointment time the cohort preferred. Patient recommendations to improve telemedicine included decreasing wait times and showing patient queue, wait time, or physician status online. Conclusions Telemedicine was strongly liked by patients during the COVID-19 pandemic. However, nearly 70% of patients still preferred in-person visits for the future.

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Protocol for stepped wedge cluster randomized trial to evaluate the effects of SurgeCon: A quality improvement emergency department surge management platform (Preprint)

10.2196/preprints.30454 ◽

2021 ◽

Author(s):

Hensley Mariathas ◽

Shabnam Asghari ◽

Oliver Hurley ◽

Nahid Anaraki ◽

Christina Young ◽

...

Keyword(s):

Quality Improvement ◽

Patient Satisfaction ◽

Health System ◽

Wait Time ◽

Cluster Randomized Trial ◽

Wait Times ◽

Hybrid Design ◽

Stepped Wedge ◽

Patient Reported ◽

Cluster Randomized

BACKGROUND Despite many efforts, long wait time and overcrowding at Emergency Departments (EDs) have remained a significant health system issue in Canada. For several years, Canada has had one of the longest wait times among Organisation for Economic Co-operation and Development OECD countries. From the patient’s perspective, the challenge has been described as “patients wait in pain or discomfort for hours before being seen at EDs”. In this study, we propose an innovative quality-improvement intervention called SurgeCon that includes a protocol-driven software platform and several other initiatives to reduce wait times and improve the sustainability of health systems without significant workforce changes. We piloted SurgeCon at an ED in Carbonear, Newfoundland and Labrador (NL) and found there was a 32% reduction in ED wait time. OBJECTIVE Our primary objectives of the trial are to evaluate the effects of SurgeCon on ED performance based on length of stay (LOS), time to physician’s initial assessment (PIA), and the number of patients leaving the ED without being seen by a physician (LWBS), patient satisfaction and patient-reported experience with ED wait times. The ultimate goal of this study is to create better value care by reducing the per-patient cost of delivering ED services. METHODS This study will investigate the effects of SurgeCon on health system key performance outcomes and patient-reported experience and satisfaction. The study uses a comparative effectiveness-implementation hybrid design. This type of hybrid design has been recommended to help achieve rapid translational gains that can hasten the movement of interventions from research to practice to public health impact. In our hybrid design, we will use a pragmatic stepped wedge cluster randomized trial (SW-CRT) design that enrols four 24/7 on-site ED physician support (category A) hospitals into a 30-month trial. All clusters (hospitals) start with a baseline period of “usual care” and are randomized to determine the order and timing of transitioning to “intervention care” until all hospitals are exposed to the intervention condition for the remainder of the study. RESULTS Data collection for this study is ongoing. To date, 15 randomly selected patients have participated in telephone interviews concerning patient-reported experiences and patient satisfaction with ED wait times. CONCLUSIONS By evaluating the mechanisms behind the use of SurgeCon, we hope to be able to improve wait times and create better value ED care in this healthcare context. CLINICALTRIAL This study is registered in ClinicalTrials.gov NCT04789902

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Influence of publicly available online wait time data on emergency department choice in patients with noncritical complaints

CJEM ◽

10.2310/8000.2012.120601 ◽

2012 ◽

Vol 14 (04) ◽

pp. 237-246 ◽

Cited By ~ 2

Author(s):

Amelia Yip ◽

Shelley McLeod ◽

Andrew McRae ◽

Bin Xie

Keyword(s):

Emergency Department ◽

Patient Satisfaction ◽

Public Awareness ◽

Wait Time ◽

Future Research ◽

Wait Times ◽

Time Data ◽

Logistic Regression Models ◽

Willingness To Use ◽

Time Information

ABSTRACTObjectives:Increased emergency department (ED) wait times lead to more patients who leave without being seen and decreased patient satisfaction. Many EDs post estimated wait times either online or in the ED to guide patient expectations. The objectives of this study were to assess patients' awareness of online wait time data and to investigate patients' willingness to use this information when choosing between two academic EDs in London, Ontario.Methods:A prospective study was conducted over a 2-month period in a tertiary ED with online available wait times. Patients over 18 years of age assigned a Canadian Triage and Acuity Scale (CTAS) score of 3, 4, or 5 were approached by trained research assistants to complete a 15-item paper-based questionnaire. Multivariable logistic regression models were used to determine factors independently associated with the outcomes.Results:A total of 1,211 patients completed the survey. Of these, 109 (9%) were aware that ED wait time information was available on the Internet; 544 (45%) reported that they would use the available data to make a decision on which ED to visit, and 536 (44%) indicated that they were more likely to go to the ED with a shorter wait time. Age, gender, household income, education, and Internet access were not associated with awareness of online ED wait times. Participants less than 40 years of age were more likely to use online wait time information.Conclusion:There is low awareness of the availability of ED wait time data published online in the study locaton. Future research may include the delivery of a public awareness strategy for ED wait time data and a re-evaluation of ED use and patient satisfaction following this.

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Improving Patient Experience of Wait Times and Courtesy Through Electronic Sign-in and Notification in the Phlebotomy Clinic

Archives of Pathology & Laboratory Medicine ◽

10.5858/arpa.2019-0139-oa ◽

2019 ◽

Vol 144 (6) ◽

pp. 769-775

Author(s):

Vincent Le ◽

Elizabeth A. Wagar ◽

Ron A. Phipps ◽

Robert E. Del Guidice ◽

Han Le ◽

...

Keyword(s):

Patient Satisfaction ◽

Patient Experience ◽

Patient Flow ◽

Wait Time ◽

Satisfaction Score ◽

Wait Times ◽

Notification System ◽

The Mean ◽

Patients Experience ◽

And Training

Context.— The phlebotomy clinic, which sees on average 900 patients a day, was faced with issues of congestion and noise due to inefficient workflow and processes. The staff called each patient name for his or her turn, and patients were unsure of wait time and position in line. These factors led to unfavorable patient satisfaction regarding wait times and courtesy of the staff. Objective.— To improve patients' experience of wait times and courtesy in the phlebotomy clinic through an electronic sign-in and notification system, redesign of the area, and training of employees. Design.— An electronic sign-in and notification system was implemented in the phlebotomy clinic. Several sign-in stations and whiteboard wall monitors were installed in the clinic, along with a redesign of the patient flow. A Press Ganey survey was given to patients after their visit which included 3 questions related to wait times, courtesy, and information about delays, respectively. The mean responses for each month between March 2016 and December 2018 were aggregated and compared for each measure. Results.— Overall, wait time saw a 7.7% increase in satisfaction score, and courtesy saw a 1.0% increase in satisfaction score during the course of the several interventions that were introduced. The operational efficiency of the clinic also saw a veritable increase because the percent of patients processed within 20 minutes increased by 27%, from 62% (8212 of 13 245 blood draws) to 89% (11 703 of 13 143 blood draws). Conclusions.— The interventions implemented proved to increase the patient satisfaction in each of the measures. The electronic sign-in and whiteboards provided valuable information to both patients and staff.

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Chemotherapy wait times in a network of pediatric oncology clinics.

Journal of Clinical Oncology ◽

10.1200/jco.2018.36.30_suppl.127 ◽

2018 ◽

Vol 36 (30_suppl) ◽

pp. 127-127

Author(s):

Carolyn Lucille Russo ◽

Jennifer Morgan ◽

Mohamed Elsaid

Keyword(s):

Patient Satisfaction ◽

Pediatric Oncology ◽

Care Delivery ◽

Wait Time ◽

Baseline Data ◽

Wait Times ◽

Pharmacy Staff ◽

Chemotherapy Administration ◽

Before And After ◽

Reduce Wait Time

127 Background: Optimizing care delivery is a satisfier for patients and providers alike. Inadequate clinic flow may also drive up costs, as staff are more likely to utilize overtime hours. We noted in our network of outpatient pediatric oncology clinics that the lowest scores in patient satisfaction surveys were the category of waiting time in the chemotherapy area. We aimed to reduce wait time in the chemotherapy area for patients receiving outpatient, lab-dependent, intravenous push chemotherapy by 5% within 9 months. Methods: A team consisting of a nurse team leader and core members (physician, nurse and pharmacist) from affiliate clinics in 3 states (AL, MO, OK) obtained baseline data over 2 weeks. Data included 1) patient arrival time, 2) lab collection time, 3) lab result time, 4) chemotherapy order time, 5) chemotherapy delivery time to clinic, 6) chemotherapy administration time. Each clinic created their individual process map and cause/effect diagram. Additional measures collected were patient satisfaction scores, parent and staff surveys before and after the intervention. Each clinic site met weekly and the network of the 3 clinics met monthly to review all results. Using the baseline data, each clinic identified points in care where interventions could reduce chemotherapy wait time based on reviewing their own and other clinics’ data. Interventions included moving lab collection earlier in the visit, additional pharmacy staff to deliver chemotherapy and placing an electronic monitor to alert providers when lab resulted. Results: Within 4 months of the interventions all sites had a reduction in chemotherapy wait times (Site A 144m-pre, 134m-post; Site B 163m-pre, 140m-post; Site C 137m-pre, 116m-post). Parent and staff surveys are in process. Conclusions: Each clinic was able to reduce chemotherapy times using different interventions depending on their internal process, moreover each clinic learned how to improve from each other’s processes.

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Improving Outpatient Infusion Clinic Wait Times at a Comprehensive Cancer Center

JCO Oncology Practice ◽

10.1200/op.21.00118 ◽

2021 ◽

pp. OP.21.00118

Author(s):

Neda Hashemi-Sadraei ◽

Shenthol Sasankan ◽

Nick Crozier ◽

Bernard Tawfik ◽

Ronald Kittson ◽

...

Keyword(s):

Quality Improvement ◽

Patient Satisfaction ◽

Working Group ◽

Outcome Measure ◽

Wait Time ◽

Comprehensive Cancer Center ◽

Secondary Outcome ◽

Cancer Center ◽

Wait Times ◽

Patient Wait Time

PURPOSE: Many factors contribute to long wait times for patients on the day of their chemotherapy infusion appointments. Longer wait time leads to nonoptimal care, increased costs, and decreased patient satisfaction. We conducted a quality improvement project to reduce the infusion wait times at a Comprehensive Cancer Center. METHODS: A multidisciplinary working group of physicians, infusion center nurses, pharmacists, information technology analysts, the Chief Medical Officer, and patient advocates formed a working group. Wait times were analyzed, and the contributing factors to long wait time were identified. Plan-Do-Study-Act cycles were implemented and included labeling patients ready to treat earlier, loading premedications into the medication dispensing system, increasing the number of pharmacy staff, and improving communication using a secure messaging system. The outcome measure was time from patient appointment to initiation of first drug at the infusion center. The secondary outcome measure was patient wait time satisfaction on the basis of Press Ganey score. RESULTS: Postintervention, the mean time from appointment to initiation of first drug decreased 17.6 minutes ( P < .001; 95% CI, 16.3 to 18.9), from 58.1 minutes to 40.5 minutes (43.5% decrease). Patient wait time satisfaction score increased 8.9 points ( P < .001; 95% CI, 6.0 to 11.82), from 76.2 to 85.1 (11.7% increase). CONCLUSION: Exploring real-time data and using a classic quality improvement methodology allowed a Comprehensive Cancer Center to identify deficiencies and prevent delays in chemotherapy initiation. This significantly improved patient wait time and patient satisfaction.

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MP27: Publishing emergency department wait times in the waiting room: implementation and evaluation of a co-designed patient centered solution

CJEM ◽

10.1017/cem.2018.181 ◽

2018 ◽

Vol 20 (S1) ◽

pp. S50-S50

Author(s):

S. Calder-Sprackman ◽

E. Klar ◽

A. Rocker ◽

E. S.H. Kwok

Keyword(s):

Patient Satisfaction ◽

Wait Time ◽

Likert Scale ◽

Initial Assessment ◽

Wait Times ◽

Clear Understanding ◽

Waiting Room ◽

Patient Rating ◽

The Impact ◽

Improve Patient

Introduction: Patients in our ED were dissatisfied with their waiting experience, which resulted in patient anxiety and complaints. In 8 months, we aimed to (1) improve patient satisfaction with the ED waiting experience from triage to physician initial assessment by a 15% improvement in patients who rate their experience very good/excellent on a Likert Scale, and (2) improve patient knowledge of ED wait time by a 50% increase in understanding on a Likert Scale. Methods: We co-designed a display with ED patients to notify those in the waiting room of their wait process and wait time. The intervention was selected after root cause diagnostics including: Fishbone exercise, Pareto Diagram, and Driver Diagram. The display was co-designed with ED patients and improved via PDSA cycles to establish information displayed and how to incorporate it into the waiting experience. After co-design, a low-fidelity display was piloted in the waiting room. Results: A family of measures were evaluated using patient/provider surveys and hospital data metrics. Outcome measures were (1) percentage of patients who rated their ED experience as very good/excellent on a Likert scale, and (2) patients who had a clear/very clear understanding of their wait time on a Likert scale. Process measures were the percentage of patients who (1) looked at the wait time display, and (2) felt they could communicate their wait time to others. Balancing measures were clerk/nurse satisfaction and self-reported interruptions of patients asking wait time. Outcomes were tracked using statistical process charts and run charts. Following display implementation, patient rating of their ED experience and patient understanding of wait time showed positive improvement. Clerks/nurses were also more satisfied with their jobs and self-reported interruptions decreased. Conclusion: A low-fidelity wait time display co-designed with patients improved patient satisfaction and understanding of ED wait times. We plan to develop an automated electronic display that resembles the low-fidelity display and evaluate the impact of the intervention on the established measures. This intervention has the potential to be sustainable, feasible for other EDs, and require minimal upkeep costs.

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Reliability of the Minimum Masking Level as Outcome Variable in Tinnitus Clinical Research

American Journal of Audiology ◽

10.1044/2020_aja-20-00047 ◽

2020 ◽

Vol 29 (3) ◽

pp. 429-435

Author(s):

Patricia C. Mancini ◽

Richard S. Tyler ◽

Hyung Jin Jun ◽

Tang-Chuan Wang ◽

Helena Ji ◽

...

Keyword(s):

Standard Deviation ◽

High Frequency ◽

Pearson Correlation ◽

Correlation Coefficients ◽

Outcome Variable ◽

Reliable Estimate ◽

Moderate Correlation ◽

Trained Subjects ◽

The Relationship ◽

Minimum Intensity

Purpose The minimum masking level (MML) is the minimum intensity of a stimulus required to just totally mask the tinnitus. Treatments aimed at reducing the tinnitus itself should attempt to measure the magnitude of the tinnitus. The objective of this study was to evaluate the reliability of the MML. Method Sample consisted of 59 tinnitus patients who reported stable tinnitus. We obtained MML measures on two visits, separated by about 2–3 weeks. We used two noise types: speech-shaped noise and high-frequency emphasis noise. We also investigated the relationship between the MML and tinnitus loudness estimates and the Tinnitus Handicap Questionnaire (THQ). Results There were differences across the different noise types. The within-session standard deviation averaged across subjects varied between 1.3 and 1.8 dB. Across the two sessions, the Pearson correlation coefficients, range was r = .84. There was a weak relationship between the dB SL MML and loudness, and between the MML and the THQ. A moderate correlation ( r = .44) was found between the THQ and loudness estimates. Conclusions We conclude that the dB SL MML can be a reliable estimate of tinnitus magnitude, with expected standard deviations in trained subjects of about 1.5 dB. It appears that the dB SL MML and loudness estimates are not closely related.

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