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

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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Improving patient satisfaction through improved telephone triage in a primary care practice

Family Medicine and Community Health ◽

10.1136/fmch-2019-000208 ◽

2019 ◽

Vol 7 (4) ◽

pp. e000208

Author(s):

Rebecca Vitale ◽

Samantha Smith ◽

Benjamin R Doolittle

Keyword(s):

Primary Care ◽

Patient Satisfaction ◽

Patient Experience ◽

Primary Care Practice ◽

Emergency Services ◽

Care Practice ◽

Telephone Triage ◽

Waiting Room ◽

Convenience Sample ◽

Number Of Patients

ObjectiveThe objective of this study was to improve the telephone communication experience for patients in a primary care practice.DesignAn exploratory survey was conducted that revealed suboptimal patient satisfaction with clinic access due to the telephone triage system. Several interventions were designed: a monthly quality meeting was established among clinic staff, all phone interactions were recorded in the electronic medical record (EMR) and clinic appointments were made available several months in advance. A follow-up survey was conducted to evaluate these interventions.SettingThe study was conducted in a multispecialty, urban-based, resident-faculty practice from November 2016 to November 2017.ParticipantsSubjects were recruited in a convenience sample from the waiting room. 200 subjects participated in the initial survey and 215 in the second survey.ResultsAfter the interventions, patients felt that their questions were answered more frequently than before (p<0.01). They also felt that appointments were easier to make (p=0.03). A similar number of patients reported seeking emergency care because they were unable to reach a provider (33.8% vs 31.9%, p=0.68). The percentage of patients who received a call back within 24 hours increased, but it was not statistically significant (38.6% vs 44%, p=0.13).ConclusionImproving telephone triage through implementing a monthly quality improvement meeting, optimising use of the EMR and opening schedules several months in advance resulted in several improvements in the patient experience, but did not change use of emergency services. Further interventions, including increased resource allocation, are needed to optimise patient experience.

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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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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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Measuring the Use of Examination Room Time in Oncology Clinics: A Novel Approach to Assessing Clinic Efficiency and Patient Flow

Journal of Oncology Practice ◽

10.1200/jop.2013.001359 ◽

2014 ◽

Vol 10 (6) ◽

pp. e385-e389 ◽

Cited By ~ 10

Author(s):

Lauren M. Hamel ◽

Robert Chapman ◽

Susan Eggly ◽

Louis A. Penner ◽

Rifky Tkatch ◽

...

Keyword(s):

Patient Flow ◽

Wait Times ◽

Use Of Resources ◽

Novel Approach ◽

Clinic Efficiency ◽

Examination Room ◽

Room Time

The authors results data can be used in the design of interventions that reduce patient wait times, increase efficient use of resources, and improve scheduling patterns.

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Multi-level QI interventions in a safety-net academic oncology clinic.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.e18665 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. e18665-e18665

Author(s):

Aparna Chakravarti Jotwani ◽

Courtney Nicole Miller-Chism ◽

Margaret Griffin Crawford ◽

Claire Mach ◽

LaToya Woods ◽

...

Keyword(s):

Patient Satisfaction ◽

Cycle Time ◽

Safety Net ◽

T Test ◽

Wait Times ◽

Patient Volume ◽

Test Analysis ◽

Cycle Times ◽

Clinic Efficiency ◽

Multi Level

e18665 Background: Clinic cycle time is a performance metric and prolonged wait times may impact patient satisfaction and/or treatment outcomes. In primary care clinics, studies show prolonged cycle times detract from patient satisfaction. Fewer studies examine specialty clinics such as oncology which require multi-faceted care. Our Harris Health System (HHS) serves a diverse county with high patient volume with physician learners and limited providers due to limited resources. Our patient satisfaction assessments previously identified prolonged wait times as an area for improvement. Our team studied and process mapped operations with the goal of improving clinic efficiency. Our primary objective is to streamline the process for our outpatient oncology appointments measured through patient cycle times. We aimed to decrease the cycle time by 25% and improve patient satisfaction. Methods: From January 2018 through December 2019, the cycle time processes for Smith Thursday Oncology Clinics in the HHS were mapped and analyzed, and sequential PDSA (Plan-Do-Study-Act) cycles were completed to reduce non-value-added time. Six-month cycle times before and after implementation of three process changes implemented were compared with t-test analysis. Next, NRC (National Research Corporation) Health patient satisfaction data for the corresponding time frames was compared with both t-test and chi-square analyses. Results: Patient cycle time from July 2018 – December 2018 was compared to July 2019 – December 2019 with a t-test analysis. Our results showed a significant (p = 0.036) reduction in cycle time. The average percent decrease in cycle time was 19%. NRC patient satisfaction data inquiries, including overall satisfaction, informed regarding appointment delays, and waiting for more than 15 minutes were reviewed for this same time frame. We found trends in all three categories showing improvements in scores with p-values of 0.483, 0.821 and 0.282 respectively. Conclusions: Through multi-level interventions we were able to significantly reduce clinic cycle times. Trends towards improvement were seen as the population assessed was in the hundreds and not thousands needed for significance. Our academic teaching model is meaningful to study as it serves a high patient volume and educates future oncologists, especially pertinent when a shortage of oncologists in anticipated in the future. Additionally, our patients receive high quality care with nursing, education and infusion services. An area for improvement is communication with patients during their cycle times and other early QI work in our clinics show patients are interested in further education. Our underserved patient population is multi-ethnic, has unassessed health literacy, and frequent language barriers. Better efficiency in the clinics and utilization of cycle time can have multiple patient benefits that warrant further work in QI.

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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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Does a waiting room video about what to expect during an emergency department visit improve patient satisfaction?

CJEM ◽

10.1017/s1481803500010356 ◽

2008 ◽

Vol 10 (04) ◽

pp. 347-354 ◽

Cited By ~ 18

Author(s):

Linda Papa ◽

David C. Seaberg ◽

Elizabeth Rees ◽

Kevin Ferguson ◽

Richard Stair ◽

...

Keyword(s):

Emergency Department ◽

Patient Satisfaction ◽

Outpatient Clinic ◽

Process Of Care ◽

Waiting Room ◽

Cross Sectional ◽

Convenience Sample ◽

The Mean ◽

Referral Line ◽

Room Time

ABSTRACT Objective: We created an instructional waiting room video that explained what patients should expect during their emergency department (ED) visit and sought to determine whether preparing patients using this video would 1) improve satisfaction, 2) decrease perceived waiting room times and 3) increase calls to an outpatient referral line in an ambulatory population. Methods: This serial cross-sectional study took place over a period of 2 months before (control) and 2 months after the introduction of an educational waiting room video that described a typical patient visit to our ED. We enrolled a convenience sample of adult patients or parents of pediatric patients who were triaged to the ED waiting room; a research assistant distributed and collected the surveys as patients were being discharged after treatment. Subjects were excluded if they were admitted. The primary outcome was overall satisfaction measured on a 5-point Likert scale, and secondary outcomes included perceived waiting room time, and the number of outpatient referral-line calls. Results: There were 1132 subjects surveyed: 551 prevideo and 581 postvideo. The mean age was 38 years (standard deviation [SD] 18), 61% were female and the mean ED length of stay was 5.9 hours (SD 3.6). Satisfaction scores were significantly higher postvideo, with 65% of participants ranking their visit as either “excellent” or “very good,” compared with 58.1% in the prevideo group (p = 0.019); however, perceived waiting room time was not significantly different between the groups (p = 0.24). Patient calls to our specialty outpatient clinic referral line increased from 1.5 per month (95% confidence interval [CI] 0.58–2.42) to 4.5 per month (95% CI 1.19–7.18) (p = 0.032). After adjusting for possible covariates, the most significant determinants of overall satisfaction were perceived waiting room time (odds ratio [OR] 0.41, 95% CI 0.34–0.48) and having seen the ED waiting room video (OR 1.41, 95% CI 1.06–1.86). Conclusion: Preparing patients for their ED experience by describing the ED process of care through a waiting room video can improve ED patient satisfaction and the knowledge of outpatient clinic resources in an ambulatory population. Future studies should research the implementation of this educational intervention in a randomized fashion.

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Using Telemedicine to Pre-Screen Sports Medicine Patients in the Ambulatory Setting Reduces Wait Times and Maximizes Provider-Patient Interaction

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119s00417 ◽

2019 ◽

Vol 7 (7_suppl5) ◽

pp. 2325967119S0041

Author(s):

Alfred Atanda ◽

Kathryn Leyden ◽

Medical Student

Keyword(s):

Patient Satisfaction ◽

Knee Pain ◽

Sports Medicine ◽

Clinic Visit ◽

Background Information ◽

Full Time ◽

Visit Time ◽

Medicine Clinic ◽

Exam Room ◽

Room Time

Objectives: Gathering of background information during a clinic visit can be time-consuming. Some medical specialties have workflows that pre-screen patients ahead of time to minimize delays. Having background information ahead of time may decrease delays and ensure that the visit is focused on physical examination, diagnosis, and treatment. We have used telemedicine to treat established patients to reduce cost and resource utilization, while maintaining high levels of patient satisfaction. It is conceivable that telemedicine could also be used to pre-screen new patients prior to their in-person clinic visit. The goal of the current study was to evaluate whether utilizing telemedicine to pre-screen new patients to our sports medicine clinic would reduce time in the exam room waiting and being seen, and overall clinic times. Methods: From June 2018 through August 2018, we utilized videoconferencing telemedicine to pre-screen all new patients to a pediatric sports medicine clinic with a chief diagnosis of knee pain. Visits were performed by full-time telemedicine pediatricians who were provided appropriate training and an intake form describing which questions should be asked. All visits utilized the American Well software platform (Boston, USA) and were performed on the patient’s personal device. During the subsequent in-person visit, the overall timing of the visit was recorded including: time checked in, time waiting in waiting room, time waiting in exam room, time spent with provider, and time-checked out, were all recorded. Similar time points were recorded for matched control patients that did not undergo telemedicine pre-screening and were seen in the traditional manner. Inclusion criteria included: being brand new to the practice and unilateral knee pain. Results: There were eight pre-screened patients and ten control patients in this cohort. Compared to controls, pre-screened patients spent less time in the exam room (19 min vs. 31 min), higher percentage of the exam room time with the provider (58% vs. 34%), higher percentage of the overall visit time with the provider (29% vs. 19.5%), and less time for the overall visit (39 min vs. 52 min). Conclusion: Pre-screening patients to obtain background information can decrease exam room waiting time and overall visit time and maximize time during the visit spent with the provider. In addition, it could potentially be used to increase throughput through the clinic and improve patient satisfaction scores.

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Applying natural language processing and machine learning techniques to patient experience feedback: a systematic review

BMJ Health & Care Informatics ◽

10.1136/bmjhci-2020-100262 ◽

2021 ◽

Vol 28 (1) ◽

pp. e100262

Author(s):

Mustafa Khanbhai ◽

Patrick Anyadi ◽

Joshua Symons ◽

Kelsey Flott ◽

Ara Darzi ◽

...

Keyword(s):

Machine Learning ◽

Systematic Review ◽

Social Media ◽

Natural Language Processing ◽

Natural Language ◽

Patient Experience ◽

Language Processing ◽

Performance Metrics ◽

Free Text ◽

Patient Feedback

ObjectivesUnstructured free-text patient feedback contains rich information, and analysing these data manually would require a lot of personnel resources which are not available in most healthcare organisations.To undertake a systematic review of the literature on the use of natural language processing (NLP) and machine learning (ML) to process and analyse free-text patient experience data.MethodsDatabases were systematically searched to identify articles published between January 2000 and December 2019 examining NLP to analyse free-text patient feedback. Due to the heterogeneous nature of the studies, a narrative synthesis was deemed most appropriate. Data related to the study purpose, corpus, methodology, performance metrics and indicators of quality were recorded.ResultsNineteen articles were included. The majority (80%) of studies applied language analysis techniques on patient feedback from social media sites (unsolicited) followed by structured surveys (solicited). Supervised learning was frequently used (n=9), followed by unsupervised (n=6) and semisupervised (n=3). Comments extracted from social media were analysed using an unsupervised approach, and free-text comments held within structured surveys were analysed using a supervised approach. Reported performance metrics included the precision, recall and F-measure, with support vector machine and Naïve Bayes being the best performing ML classifiers.ConclusionNLP and ML have emerged as an important tool for processing unstructured free text. Both supervised and unsupervised approaches have their role depending on the data source. With the advancement of data analysis tools, these techniques may be useful to healthcare organisations to generate insight from the volumes of unstructured free-text data.

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Patient Satisfaction and Short-Term Outcome in Elective Cranial Neurosurgery

Neurosurgery ◽

10.1227/neu.0000000000000931 ◽

2015 ◽

Vol 77 (5) ◽

pp. 769-776 ◽

Cited By ~ 11

Author(s):

Elina Reponen ◽

Hanna Tuominen ◽

Juha Hernesniemi ◽

Miikka Korja

Keyword(s):

Patient Satisfaction ◽

Quality Of Care ◽

Health Status ◽

Patient Experience ◽

University Hospital ◽

Term Outcome ◽

Major Morbidity ◽

Patient Reported ◽

Relationship Of

Abstract BACKGROUND: Patient-reported experience is often used as a measure for quality of care, but no reports on patient satisfaction after cranial neurosurgery exist. OBJECTIVE: To study the association of overall patient satisfaction and surgical outcome and to evaluate the applicability of overall patient satisfaction as a proxy for quality of care in elective cranial neurosurgery. METHODS: We conducted an observational study on the relationship of overall patient satisfaction at 30 postoperative days with surgical and functional outcome (modified Rankin Scale [mRS] score) in a prospective, consecutive, and unselected cohort of 418 adult elective craniotomy patients enrolled between December 2011 and December 2012 at Helsinki University Hospital, Helsinki, Finland. RESULTS: Postoperative overall (subjective and objective) morbidity was present in 194 (46.4%) patients; yet almost 94% of all study patients reported high overall satisfaction. Low overall patient satisfaction at 30 days was not associated with postoperative major morbidity in elective cranial neurosurgery. Dependent functional status (mRS score ≥3) at 30 days, minor infections, poor postoperative subjective overall health status, and patient-reported severe symptoms (double vision, poor balance) may contribute to unsatisfactory patient experience. CONCLUSION: Overall patient satisfaction with elective cranial neurosurgery is high. Even 9 of 10 patients with postoperative major morbidity rated high overall patient satisfaction at 30 days. Overall patient satisfaction may merely reflect patient experience and subjective postoperative health status, and therefore it is a poor proxy for quality of care in elective cranial neurosurgery.

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