scholarly journals Patients’ Waiting Time in a University Health Clinic

2021 ◽  
Vol 6 (1) ◽  
pp. 21-26
Author(s):  
Mohd Shaiful Ehsan Shalihin ◽  
Sakinah Md Rifin
Keyword(s):  
Waiting Time ◽  
Time Management ◽  
Best Practice ◽  
Descriptive Analysis ◽  
Health Clinic ◽  
P Value ◽  
Time Duration ◽  
Mean Waiting Time ◽  
Number Of Patients ◽  
Consultation Time

Best practice management of a clinic can be measured through the achievement of appropriate waiting time and consultation time. These are important, especially in dealing with stable common cases seen in primary care. Among important associated factors include the number of patients per day, which can be various according to different operating days. Methods: This study aims to measure the waiting time and consultation time of common cases seen in the university health clinic for two weeks duration. The ‘time in’ and ‘time out’ information was captured on the information sheet attached to the patient’s registration slip. A descriptive analysis was done for common complaints, waiting time and consultation time duration. Kruskal-Wallis test was used to identify the association between different working days with waiting time and consultation time. Results: The results revealed a good mean waiting time 11.93 min (SD, 9.99) and consultation time 10.54 minutes (SD, 8.78) for the clinic. Waiting time is significantly associated with different operating days (P value < 0.05). Conclusion: The clinic’s waiting and consultation time is acceptable according to the target set by the Ministry of Health. However, further modification can be done to improve the time management of the clinic, specifically for the busy day.

HOW TO REPORT AND MONITOR THE PERFORMANCE OF WAITING LIST MANAGEMENT

2002 ◽  
Vol 18 (3) ◽  
pp. 611-618
Author(s):  
Markus Torkki ◽  
Miika Linna ◽  
Seppo Seitsalo ◽  
Pekka Paavolainen
Keyword(s):  
Hallux Valgus ◽  
Waiting Time ◽  
Varicose Vein ◽  
Elective Surgery ◽  
Waiting Times ◽  
Waiting List ◽  
Mean Waiting Time ◽  
Number Of Patients ◽  
Potential Problems ◽  
Queue Discipline

Objectives: Potential problems concerning waiting list management are often monitored using mean waiting times based on empirical samples. However, the appropriateness of mean waiting time as an indicator of access can be questioned if a waiting list is not managed well, e.g., if the queue discipline is violated. This study was performed to find out about the queue discipline in waiting lists for elective surgery to reveal potential discrepancies in waiting list management. Methods: There were 1,774 waiting list patients for hallux valgus or varicose vein surgery or sterilization. The waiting time distributions of patients receiving surgery and of patients still waiting for an operation are presented in column charts. The charts are compared with two model charts. One model chart presents a high queue discipline (first in—first out) and another a poor queue discipline (random) queue. Results: There were significant differences in waiting list management across hospitals and patient categories. Examples of a poor queue discipline were found in queues for hallux valgus and varicose vein operations. Conclusions: A routine waiting list reporting should be used to guarantee the quality of waiting list management and to pinpoint potential problems in access. It is important to monitor not only the number of patients in the waiting list but also the queue discipline and the balance between demand and supply of surgical services. The purpose for this type of reporting is to ensure that the priority setting made at health policy level also works in practise.

scholarly journals Abbreviated (8 hours) versus Traditional (24 hours) Postpartum MgSO4 Prophylaxis in Severe Preeclampsia: A Randomised Control Trial

2021 ◽  
Author(s):  
Shyamal Dasgupta ◽  
Anindya Das ◽  
Anurag Mallick ◽  
Chiranjit Ghosh
Keyword(s):  
Magnesium Sulphate ◽  
Total Duration ◽  
Severe Preeclampsia ◽  
Randomised Control Trial ◽  
Controlled Study ◽  
P Value ◽  
Time Duration ◽  
Traditional Group ◽  
Suitable Alternative ◽  
Number Of Patients

Introduction: Preeclampsia is a multisystem disorder affecting pregnancy after 20 weeks of gestation featured by hypertension and proteinuria. Magnesium Sulphate (MgSO4) has been used for 24 hours following delivery to prevent eclampsia in patients with severe preeclampsia. Aim: To determine the need to continue magnesium sulphate therapy 8 hours following delivery. Materials and Methods: The double blinded randomised controlled study was performed in the Department of Gynaecology and Obstetrics at R.G. Kar Medical College, Kolkata, West Bengal, India, from 1st July 2015 to 30th June 2016. Total 90 patients with severe preeclampsia were randomised in two group. In group A MgSO4 was discontinued 8 hours following delivery (abbreviated group) and in the group B it was continued for 24 hours following delivery (traditional group). The primary objective of study was to determine the need to continue MgSO4 therapy 8 hours following delivery. Secondary objectives were monitoring time by doctors, nursing care time, postpartum ambulation time, duration of urinary catheterisation, minor complication like urinary tract infection, duration and total dose of MgSO4 therapy. In order to calculate statistical significance of the different variables in between two groups, Student’s independent sample’s t-test was used for normally distributed numerical values and Chi-square test or Fischer’s-exact test was used for unpaired proportion data. Results: In abbreviated group, the number of patients (n=1) who did not need to continue MgSO4 therapy beyond 8 hours following delivery as safety measures were statistically significant (p-value <0.0001) in comparison to traditional group. Total duration and dose of MgSO4 therapy were significantly less (p-value <0.0001) in the abbreviated group. There was statistically significant reduction in time from delivery to postpartum ambulation and duration of indwelling urinary catheter in the abbreviated group. Conclusion: The abbreviated (8 hours) regime of postpartum MgSO4 for seizure prophylaxis is a suitable alternative to the traditional (24 hours) regime.

scholarly journals Assessment of Diabetic Patient Waiting Time in A Primary Healthcare Clinic

2020 ◽  
Vol 19 (2) ◽  
Author(s):  
Shalihin SE ◽  
Firzada I ◽  
Din MH
Keyword(s):  
Diabetic Patient ◽  
Waiting Time ◽  
Sampling Method ◽  
Primary Care Clinic ◽  
Early Morning ◽  
Health Clinic ◽  
Diabetic Patients ◽  
Care Clinic ◽  
Patient Waiting Time ◽  
Consultation Time

Introduction: Long waiting time is a common issue complained by diabetic patients that came for an early morning appointment in a health clinic. Therefore, an audit was conducted among diabetic patients in a primary care clinic with the aim to assess the patients’ waiting time and to formulate strategies for improvement. Methods: This audit was conducted for four weeks using a universal sampling method in November 2017. All diabetic patients who attended the clinic during this period were included except those who required longer period such as critically ill patients or those who came for repeat medication or procedures. The arrival and departure time for each station was captured using the modified waiting time slip, which is manually filled at every station. The waiting and consultation time for registration, screening, laboratory investigation, diabetic educator, doctor and pharmacy were recorded. The data were entered into the statistical software SPSS version 17 for analysis. Results: Results showed that all patients were registered within 11.0 minutes (SD=2.52min). Average total waiting time to see a diabetic educator and a doctor was 20.9 minutes (SD=15.53min) and 33.23 minutes (SD=27.85min), respectively. Average waiting time for other stations was less than 10 minutes. Average total time spend in the clinic for a diabetic patient was 107.58 minutes, which is comparable to a non-diabetic patient. The identified problems were due to the poor tracing and filing system. Conclusion: Improvement strategies recommended include enforcing early file tracing prior to appointment and providing a checklist for consultation by doctors and diabetic educators.

scholarly journals An audit of waiting times in the outpatient clinic in Inverness Sector A NHS Highland during the COVID-19 pandemic

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S113-S113
Author(s):  
Oksana Zinchenko ◽  
Jennifer Hyland
Keyword(s):  
Mental Health ◽  
Waiting Time ◽  
Waiting Times ◽  
Health Assessment ◽  
Outpatient Service ◽  
Bimodal Distribution ◽  
Patient Record ◽  
Mental Health Assessment ◽  
Mean Waiting Time ◽  
Number Of Patients

AimsThis audit was to assess and improve the organizational efficiency of referrals to Inverness Sector A Outpatient Service. The referrals were audited to measure the average waiting time from referral to first offered outpatient appointment and to assess the proportion of patients waiting longer than 12 weeks.MethodThe audit included routine referrals to the CMHT Inverness Sector A, NHS Highland from GP practices: Kingsmills, Burnfield, Riverside, Fairfield, Foyers and Drumnadrochit Medical Practices. The number of referrals and the number and proportion of clients given appointments for assessments were calculated. Referrals were received directly from primary care and the Mental Health Liaison Team or following Out of Hours contacts at the Mental Health Assessment Team.Data were collected retrospectively: referrals from 1 Jan 2020–31 Aug 2020. Sample size came to 160 patients aged 16–65 years. Data were collected via review of recorded documentation on the NHSH electronic patient record systems (SCIstore), from 5th–25th January 2021.Result160 patients (male 82, female 78) were referred from 1 Jan to 1 Sept 2020. Of these, 140 (87.5%) were given an appointment for an assessment. The mean waiting time was 12 weeks for 103 patients (64%), with 57 patients (36%) waiting longer than 13 weeks. The bimodal distribution of waiting times prompted an analysis of those with longer waiting times. In some instances, appointments were delayed because patients either did not attend (DNA) or cancelled their appointments. Reasons for delays included: postponement until further information was available; cancellation of meetings or patients DNA. In 20 cases (12.5%), the referrals deemed inadequate, prompting further liaison with the referrer for clarification about the nature of the problem and previous psychological interventions.ConclusionThe number of transactions (any amendment to a patient record) was higher than the number of patients affected, as several transactions can relate to one patients’ record.Most referrals are vetted in advance via the daily Inverness triage huddle. Ways of improving the quality of information provided by referrers would be explored.On receipt of each referral, the date of the 12 week deadline would be calculated and highlighted in a database.The cross-sector (Highland wide) standardisation will add clarity about medical capacity, that does not involve use of excessive clinician time.

PENINGKATAN KUALITAS HIDUP MELALUI LOGOTERAPI PADA KLIEN YANG MENJALANI HEMODIALISIS

2019 ◽  
Vol 11 (1) ◽  
pp. 9-18
Author(s):  
Abdul Wakhid ◽  
Ana Puji Astuti ◽  
Maya Kurnia Dewi
Keyword(s):  
Quality Of Life ◽  
Renal Failure ◽  
Test Group ◽  
Sampling Technique ◽  
T Test ◽  
P Value ◽  
Number Of Patients ◽  
Post Test ◽  
The Mean

Logoterapi merupakan terapi untuk menemukan makna positif dibalik sebuah kejadian yang tidak diharapkan. Logoterapi dilaksanakan secara individu maupun berkelompok dalam bentuk konseling dan berorientasi pada pencarian makna hidup individu. Tujuan logoterapi meningkatkan makna pengalaman hidup individu yang diarahkan kepada pengambilan keputusan yang bertanggung jawab. Penelitian ini dilakukan dengan menggunakan rancangan pre-experiment dengan metode pre and post test group, artinya pengumpulan data dilakukan terhadap responden untuk membandingkan kualitas hidup sebelum dan sesudah dilakukan intervensi. Teknik pengambilan sampel dilakukan dengan metode total sampling yaitu pengambilan seluruh sampel dengan tetap memperhatikan kriteria yang telah ditetapkan. Jumlah pasien yang menjalani hemodialisis di RSUD Ungaran sebanyak 21 orang dan di RSUD Ambarawa sebanyak 25 pasien. Analisis data dilakukan dengan menggunakan uji t test dependent. Hasil penelitian didapatkan bahwa dari 46 responden didapatkan rata-rata skor kualitas hidup pasien yang mejalani hemodialisis sebesar 60.22 dengan skor terrendah 55 dan skor tertinggi 69. Bahwa dari 46 responden didapatkan rata-rata skor kualitas hidup pasien yang mejalani hemodialisis sebesar 88.72 dengan skor terrendah 79 dan skor tertinggi 103. Hasil uji statistik dengan uji t test dependent diketahui ada pengaruh logoterapi terhadap kemampuan memaknai hidup pada klien yang menjalani hemodialisis di RSUD Kabupaten Semarang (p value: 0,0001). Saran perlunya peningkatan kemampuan perawat dalam memberikan layanan kesehatan termasuk pemberian atau pemanduan penemuan makna hidup bagi pasien hemodialysis, agar selain dengan hemodialysis, ada faktor internal dari pasien yang dapat dijadikan sebagai motivasi untuk sembuh dari penyakit.   Kata Kunci: Logoterapi, kualitas hidup   IMPROVE THE QUALITY OF LIFE OF PATIENTS WITH RENAL FAILURE WHO UNDERWENT HEMODIALYSIS   ABSTRACT Logotherapy is a therapy to discover the positive meaning behind an unexpected event. Logotherapy is carried out individually or in groups in the form of counseling and oriented to the search for the meaning of individual life. This study aims to improve the quality of life of patients with renal failure who underwent hemodialysis. This research was conducted by using pre-experiment with pre-post test study. The sampling technique was done by the convenience sampling. The number of patients undergoing hemodialysis as many as 46 respondents. Data analysis was done by using test t test dependent. The result showed that from 46 respondents got the mean of quality of life of patients who had hemodialysis 60.22 with lowest score 55 and highest score 69. Whereas from 46 respondents got the mean score of life quality of patients who had hemodialysis 88.72 with score the lowest score 79 and the highest score 103. The result of statistical test with t test dependent is known there is influence of logoterapi to the ability of meaningful life on client who undergo hemodialysis at Semarang Regency hospitals (p value: 0.0001). Advice on the need to improve the nurse's ability to provide health services, including the provision or guidance of the discovery of the meaning of life for hemodialysis patients, in addition to hemodialysis, there are internal factors of the patient that can be used as a motivation to recover from illness.   Keywords: Logotherapy, quality of life, kidney failure.  

Correlation Between Serological Makers and Immunofluorescence Deposits i n Kidney Tissue of Patients with Lupus Nephritis

2019 ◽  
Vol 9 (02) ◽  
Author(s):  
Haider S Al-Hadad ◽  
Aqeel Abbas Matrood ◽  
Maha Abdalrasool Almukhtar ◽  
Haider Jabur Kehiosh ◽  
Riyadh Muhi Al-Saegh
Keyword(s):  
Lupus Nephritis ◽  
Lupus Erythematosus ◽  
Kidney Biopsy ◽  
Pearson Correlation ◽  
Standard Procedure ◽  
Kidney Tissue ◽  
P Value ◽  
American College Of Rheumatology ◽  
Immune Deposits ◽  
Number Of Patients

Background: Systemic lupus erythematosus (SLE) is an autoimmune disease. Few biomarkers for SLE have been validated and widely accepted for the laboratory follow-up of inflammatory activity. In SLE patients, with lupus nephritis (LN), complement activation leads to fluctuation of serum C3 and C4 that are frequently used as clinicalm biomarker of disease activity in SLE. Patients and Methods: In this study the number of patients were 37, seven patients were excluded for incomplete data collection, 28 were females ,2 were males. The duration of the study is two years from 2015 to 2017. Patients were considered to have SLE and LN according to American College of Rheumatology (ACR) criteria, and International Society of Nephrology/ Renal Pathology Society (ISN/RPS). All patients were evaluated withm clinical presentation, laboratory investigations. Our patients underwent kidney biopsy according to standard procedure by Kerstin Amann, and their tissue specimens were studied in the laboratory with light microscope (LM) and immunofluorescence microscope reagents. The relationship between the serological markers and immunofluorescence deposits in kidney biopsy of all patients were studied using the statistical analysis of Pearson correlation and single table student's T test. A P value 0.05 was considered statistically significant. Results: The granular pattern of IF deposits was present in all LN patients, and in more than two third of patients these IF deposits presented in glomerular, tubular, and mesangium sites. While less than one third of patients had IF deposits in the mesangium only. There was no statistically significant correlation between serum ANA, anti-dsDNA, and IF deposits of different types. There was significant correlation between serum C3 and C4 hypocomplementemia and IgG immune deposits in kidney biopsy, and there was significant relationship between serum C3 hypocomplementemia and full house immunofluorescence (FHIF) deposits inm kidney biopsy.Conclusions:Immunofluorescence deposits is mainly granular pattern in LN patients. There was no significant association between serum ANA, anti-dsDNA, and immune deposits in kidney tissue. Immunofluorescence deposits of IgG type correlates significantly with serum C3 and C4 hypocomplemetemia, and these immune deposits in association with low complement levels correlates with LN flare. There was significant correlation between C3 hypocomplementemia and FHIF.

HUBUNGAN ANTARA MANAJEMEN WAKTU BELAJAR, MOTIVASI BELAJAR, DAN FASILITAS BELAJAR DENGAN PRESTASI BELAJAR MATEMATIKA SISWA SMP KELAS VIII SE-KECAMATAN DANUREJAN YOGYAKARTA

2016 ◽  
Vol 4 (3) ◽  
Author(s):  
Nurita Juliasari ◽  
Benedictus Kusmanto
Keyword(s):  
Time Management ◽  
Hypothesis Test ◽  
Mathematics Learning ◽  
Descriptive Analysis ◽  
Motivation To Learn ◽  
Test Technique ◽  
Learning Achievement ◽  
Learning Time ◽  
8Th Grade ◽  
Major Hypothesis

The purpose of the research was to find out correlate between learn time management, motivation to learn, and learning facilities with mathematics learning achievement on 8th  grade students at the whole district of Danurejan Yogyakarta. The genre of this research is descriptive researchment. The population in this research were all students of 8th grade students at the whole district of Danurejan Yogyakarta with amount 593 students and the samples taken at proportional random sampling with amount 113 students. Data collection method used was a questionannaire and a test technique. Analysis using descriptive analysis of data, multiple regression, and partial correlation. In the major hypothesis test is obtained R = 0,747 and R2 = 0,558 with sig=0,000 < 0,05. Then in the first minor hypothesis test is obtained ry1-23 = 0,443 with         sig=0,000 < 0,05; the second minor hypothesis test is obtained ry2-13 = 0,370 with sig=0,000 < 0,05; and the minor third hypothesis test is obtained ry3-12 = 0,344 with sig=0,000 < 0,05. So there is a positive and significant correlation between learning time management, motivation to learn, and learning facilities with mathematics learning achievement on 8th grade students at the whole district of Danurejan Yogyakarta as collective and partial. It is expected that students care about learning time management, motivation to learn, and learning facilities to  mathematics learning achievement increasingly.

DAMPAK PENERAPAN BEA MASUK ANTI-DUMPING ATAS IMPOR PRODUK TINPLATE

2020 ◽  
Vol 4 (1) ◽  
Author(s):  
Marsanto Adi Nurcahyo ◽  
Aditya Subur Purwana
Keyword(s):  
Free Trade ◽  
Descriptive Analysis ◽  
Secondary Data ◽  
P Value ◽  
Import Duty ◽  
Domestic Production ◽  
The Mean ◽  
Mean Equality ◽  
Equality Test

ABSTRACT:Anti-dumping on tinplate products aim to protect domestic industries. Still, some industries want tinplate products not to be subject to anti-dumping because domestic production is not sufficient. This research examines the application of anti-dumping import duties on tinplate products from China, Taiwan, and Korea from 2014 to 2018, to know whether there are differences in the value of imports before and during the anti-dumping import duty. Use secondary data sourced from UN-Comtrade. Samples are selected by countries that have continuously sent tinplate products to Indonesia from 2010 to 2018, namely China, Taiwan, Korea, Japan, Germany, India, and Malaysia. Using the Mean Equality Test, it is known that there are differences in the import value before and during the anti-dumping import duty, with a p-value of 0.0114 less than α (0.05), so it is concluded that there is a difference in the import value of the tinplate product before and during anti-dumping duty. Descriptive analysis results illustrate imports from China and Taiwan tend to decrease. In contrast, imports from Korea tend to increase despite being subjected to anti-dumping duties because they can compete by using preferential tariffs based on free trade schemes.Keywords: Antidumping, Import duty, TinplateABSTRAK:Anti-dumping terhadap produk tinplate bertujuan melindungi industri dalam negeri, akan tetapi terdapat ìndustri yang menginginkan produk tinplate tidak dikenakan anti-dumping karena produksi dalam negeri belum mencukupi. Penelitian ini menguji penerapan bea masuk anti-dumping terhadap produk tinplate dari China, Taiwan dan Korea selama tahun 2014 s.d. 2018, dengan tujuan mengetahui apakah ada perbedaan nilai importasi sebelum dan selama dikenakan bea masuk anti-dumping. Menggunakan data sekunder yang bersumber dari UNComtrade. Sampel dipilih negara yang secara kontinyu mengirim produk tinplate ke Indonesia sejak 2010 s.d. 2018, yaitu China, Taiwan, Korea, Jepang, Jerman, India dan Malaysia. Menggunakan Mean Equality Test, diketahui terdapat perbedaan nilai importasi sebelum dengan selama dikenakan bea masuk anti-dumping. Hasil penelitian menunjukkan bahwa nilai-P (p-value) adalah 0,0114 lebih kecil dari alpha (α=0,05), sehingga disimpulkan terdapat perbedaan pada nilai importasi produk tinplate sebelum dengan selama dikenakan bea masuk anti-dumping. Hasil analisis deskriptif menggambarkan importasi dari China dan Taiwan cenderung menurun sedangkan importasi dari Korea cenderung naik walaupun dikenakan bea masuk anti-dumping karena mampu bersaing dengan menggunakan tarif preferensi berdasarkan skema perdagangan bebas.Kata Kunci: Anti-dumping, Bea Masuk, tinplate

COMPARISON OF EFFECTIVENESS OF MOBILIZATION AND SELF-EXERCISES IN ADHESIVE CAPSULITIS OF SHOULDER

2018 ◽  
Vol 7 (1) ◽  
pp. 35-41
Author(s):  
Muhammad Usman Khan ◽  
Ghazala Noor Nizami ◽  
Ali Farhad
Keyword(s):  
Pain Intensity ◽  
Adhesive Capsulitis ◽  
Descriptive Analysis ◽  
Tertiary Care ◽  
Sampling Technique ◽  
Simple Random Sampling ◽  
T Test ◽  
P Value ◽  
Group A ◽  
Group B

OBJECTIVE To compare the effectiveness of mobilization and self-exercises in the management of adhesive capsulitis of shoulder STUDY DESIGN Randomized Control Trial SAMPLE SELECTION 30 patients of adhesive capsulitis of shoulder from physiotherapy department of tertiary care hospitals of Karachi were selected through simple random sampling technique. PROCEDURE Treatment was continued for 5 days per week for the period of 3 weeks followed by assessment. Patients were randomly divided into two equal groups. Group A was treated with midrange mobilization while group B performed self-exercises. Both groups received TENS and hot pack prior to the exercises. Mean ± SD, frequencies and percentages were used for descriptive analysis. ROM via goniometry and pain intensity through VAS was analyzed by paired t-test within the groups and by independent t-test between the groups, using SPSS. P-value of less than 0.05 was considered significant. RESULTS 60% were females (n=18) and 40% were males (n=12) with mean age of 50.17±6.37 years. Significant improvement (p-value <0.05) in pain and shoulder ROM was observed among patients of Group A as compared to Group B. Pain intensity was decreased to 1.67 ± 0.62 in group A, whereas ROMs in these patients were also better than other group.

scholarly journals The Impact of Longer Consultation Time: A Simulation-Based Approach

2020 ◽  
Vol 11 (05) ◽  
pp. 857-864
Author(s):  
Abdulrahman M. Jabour
Keyword(s):  
Waiting Time ◽  
Quality Care ◽  
Working Hours ◽  
Discrete Events ◽  
Simulation Based ◽  
Patient Waiting Time ◽  
Free Environment ◽  
The Impact ◽  
Consultation Time ◽  
Patient Waiting

Abstract Background Maintaining a sufficient consultation length in primary health care (PHC) is a fundamental part of providing quality care that results in patient safety and satisfaction. Many facilities have limited capacity and increasing consultation time could result in a longer waiting time for patients and longer working hours for physicians. The use of simulation can be practical for quantifying the impact of workflow scenarios and guide the decision-making. Objective To examine the impact of increasing consultation time on patient waiting time and physician working hours. Methods Using discrete events simulation, we modeled the existing workflow and tested five different scenarios with a longer consultation time. In each scenario, we examined the impact of consultation time on patient waiting time, physician hours, and rate of staff utilization. Results At baseline scenarios (5-minute consultation time), the average waiting time was 9.87 minutes and gradually increased to 89.93 minutes in scenario five (10 minutes consultation time). However, the impact of increasing consultation time on patients waiting time did not impact all patients evenly where patients who arrive later tend to wait longer. Scenarios with a longer consultation time were more sensitive to the patients' order of arrival than those with a shorter consultation time. Conclusion By using simulation, we assessed the impact of increasing the consultation time in a risk-free environment. The increase in patients waiting time was somewhat gradual, and patients who arrive later in the day are more likely to wait longer than those who arrive earlier in the day. Increasing consultation time was more sensitive to the patients' order of arrival than those with a shorter consultation time.

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