Visit Length Research Articles

Improving efficiency in preoperative assessment: A pilot study on visit times for preoperative evaluation

PurposePreoperative clinics are an increasingly common mechanism for preoperative evaluation. Factors predicting prolonged visit times are poorly understood. Our objective was to identify patient factors that would allow non-medically trained staff to determine appropriate scheduling needs. MethodsAt the preoperative assessment center of a tertiary care hospital, patient data were prospectively collected on 25 risk factors hypothesized to be related to a prolonged visit length, defined as greater than the unit benchmark of 75 min. The association between these risk factors and prolonged visit length was assessed. ResultsData were collected on 1053 patients seen at the preoperative center over a two month period. The median patient age was 58 years (interquartile range [IQR]: 47, 67). A total of 446 patients (42%) had a prolonged visit length. Significant multivariate predictors of a prolonged visit length were: age greater than 80 years (p = 0.003), taking >6 prescription medications (p = 0.0002), functional status of <3 metabolic equivalents (p = 0.002), currently having > 3 medical providers (p = 0.0005), inability to explain details of one's medical history (p = 0.001), and planned ICU postoperative stay (p = 0.0004). ConclusionsPredictors of prolonged visit length include factors that can be obtained prior to the date of evaluation. Scheduling models integrating such predictors into workflow processes have the potential to improve patient care and allow for more efficient use of resources for the preoperative assessment.

Validity of the Japan Acuity and Triage Scale in adults: a cohort study

ObjectiveThe Japan Acuity and Triage Scale (JTAS) was developed based on Canadian Triage and Acuity Scale in 2012 and has been implemented in many Japanese EDs. We assessed the validity...

Satisfaction with Healthcare Received at an Interprofessional Student-run Free Clinic: Invested in Training the Next Generation of Healthcare Professionals.

Most medical schools in the United States have an associated student-run free clinic (SRFC) providing medical care to the underserved population around the campus. SRFCs provide students with opportunities to practice history-taking and diagnosis skills. There have been a few studies that have evaluated patient satisfaction within SRFCs; however, these studies report limited aspects of care within these clinics. This study hopes to determine the levels of satisfaction with clinical staff and operations and to ensure that the medical needs of patients are being met. Results showed that 91% of the patients were satisfied or very satisfied with their overall clinic experience. The highest scoring parameters were “courtesy/respect of staff”, “availability of free or affordable medications”, and “doctor’s knowledge”. Overall, the patients are satisfied with the staff, care, and availability of medicine provided by the Keeping Neighbors in Good Health Through Service (KNIGHTS) clinic. Most patients enjoy participating in the training and education of future physicians and would recommend this clinic to a friend or family member. The lowest satisfaction rates were associated with length of visit and wait time. In the future, SRFCs should work together to assess patient satisfaction in the clinics, identify problem areas, and develop generalizable interventions for improvement.

A Time-Motion Study of Primary Care Physicians' Work in the Electronic Health Record Era.

Electronic health records (EHRs) have had mixed effects on the workflow of ambulatory primary care. In this study, we update previous research on the time required to care for patients in primary care clinics with EHRs. We directly observed family physician (FP) attendings, residents, and their ambulatory patients in 982 visits in clinics affiliated with 10 residencies of the Residency Research Network of Texas. The FPs were purposely chosen to reflect a diversity of patient care styles. We measured total visit time, previsit chart time, face-to-face time, non-face time, out-of-hours EHR work time, and total EHR work time. The mean (SD) visit length was 35.8 (16.6) minutes, not counting resident precepting time. The mean time components included 2.9 (3.8) minutes working in the EHR prior to entering the room, 16.5 (9.2) minutes of face-to-face time not working in the EHR, 2.0 (2.1) minutes working in the EHR in the room (which occurred in 73.4% of the visits), 7.5 (7.5) minutes of non-face time (mostly EHR time), and 6.9 (7.6) minutes of EHR work outside of normal clinic operational hours (which occurred in 64.6% of the visits). The total time and total EHR time varied only slightly between faculty physicians, third-year and second-year residents. Multivariable linear regression analysis revealed many factors associated with total visit time including patient, physician, and clinic infrastructure factors. Primary care physicians spent more time working in the EHR than they spent in face-to-face time with patients in clinic visits.

Every Minute Counts: Using Process Improvement and Performance Feedback to Improve Patient Flow in an Emergency Department

ABSTRACTProlonged emergency department (ED) visits are associated with a number of adverse outcomes for patients as well as lower patient satisfaction scores and increased costs. Several factors that influence the length of ED visits are out of the control of hospital employees, but some opportunities exist to improve performance. For this study, the ED department of a 150-bed hospital in the southeastern United States wanted to improve door-to-discharge time. To do so, a subprocess of door-to-discharge time was targeted, door-to-order. After analyzing the process, the team created standard orders for the 10 most common presenting conditions in the ER with preapproval, allowing nurses to submit the orders without the provider first visiting the patient. Following the process change, daily feedback was added to increase utilization of the preapproved orders. Reductions in door-to-order times and door-to-discharge were observed and patient satisfaction remained stable. Implications for future research in this area are discussed.

Emergency department performances during overcrowding: the experience of the health protection agency of Brianza.

Background: Hospital emergency departments (ED) can contribute to improve health outcomes and reduce costs of health care system. This study evaluated ED admissions during a twelve months period, analyzing characteristics of patients who underwent to emergency care in order to understand factors involved in ED overcrowding and promote adequate management. Methods: This retrospective study analyzed a twelve months window, with in-depth focus on December/January when almost all EDs reported overcrowding. All ED admissions were recorded in electronic schedules including: demographic characteristics, time/date of the access, incoming triage code, diagnosis, performed procedures, discharge, time/date of discharge. A backward multivariable logistic regression model was used to estimate relationships between investigated variables and ED pattern mortality. Results: A total of 416,299 ED admissions were analyzed. During the overcrowded period there was an increase in patients admissions (+32 patients per day, p = 0.0079) with a statistically significant rise of critical patients (+1.7% yellow codes and +0.7% red codes, p < 0.001) and older subjects (+1.4% patients aged 75 or more years, p < 0.001). Moreover, there were statistically significant increases in waiting times and in length of visits, a higher percentage of patients who were hospitalized (13.3% vs. 12.2%, p < 0.001), left ED (4.46% vs. 4.15%, p < 0.001) and died (0.27% vs. 0.17%, p < 0.0001). This latter result maintained a marginal statistical significance (OR = 1.16, 95% CI = 0.98–1.38, p = 0.075) after adjustment for confounding. Conclusion: Our study highlights that ED crowding can determine measurable worsening in ED services and patient outcomes as mortality, waiting times, lengths of stay, percentage of abandonment without being seen and, probably, costs. Thus, address ED crowding has to be considered an important public health priority requiring policymakers involvement.

TDABC Cost Analysis of Ocular Disorders in an Ophthalmology Emergency Department versus Urgent Care: Clinical Experience at Massachusetts Eye and Ear

Purpose To perform a cost analysis comparison for managing common ocular disorders in an eye emergency department (ED) versus an urgent care setting using a time-driven activity-based cost model (TDABC) to assist physicians and staff in appropriate allocation of resources at their own institution. Design Retrospective analysis. Setting Massachusetts Eye and Ear (MEE) ED and Same-Day Services (SDS), which runs as an urgent care clinic. Population Patients diagnosed with corneal abrasions, dry eyes, conjunctivitis, and styes were identified between April 2014 and August 2015 (n = 2,408 [ED], 26 [SDS]). We determined resources used in delivery of care, which included personnel, consumables, space capacity, and equipment. Costs were identified based on time the patient spent with each resource. Main Outcome Average visit length and associated personal, space, equipment, and consumable costs. Results Average visit length was 196 and 53 minutes, respectively, primarily due to longer wait times in the ED. Personnel and space costs were higher in the ED compared with SDS ($68.92 vs. $51.37 and $24.44 vs. $12.86, respectively). This led to an overall higher total resource cost for patients seen in the ED compared with SDS ($108.41 vs. $81.53, respectively). Conclusion For common ocular disorders, total SDS costs were 25% less than ED costs at MEE primarily due to personnel and space utilization. Treating patients with nonemergent ocular problems outside the ED can lead to shorter visit times for patients as well as lower overall costs.

'The Hand on the Doorknob': Visit Agenda Setting by Complex Patients and Their Primary Care Physicians.

Choosing which issues to discuss in the limited time available during primary care visits is an important task for complex patients with chronic conditions. We conducted sequential interviews with complex patients (n = 40) and their primary care physicians (n = 17) from 3 different health systems to investigate how patients and physicians prepare for visits, how visit agendas are determined, and how discussion priorities are established during time-limited visits. Visit flow and alignment were enhanced when both patients and physicians were effectively prepared before the visit, when the patient brought up highest-priority items first, the physician and patient worked together at the beginning of the visit to establish the visit agenda, and other team members contributed to agenda setting. A range of factors were identified that undermined the ability of patient and physicians to establish an efficient working agenda: the most prominent were time pressure and short visit lengths, but also included differing visit expectations, patient hesitancy to bring up embarrassing concerns, electronic medical record/documentation requirements, differences balancing current symptoms versus future medical risk, nonactionable items, differing philosophies about medications and lifestyle interventions, and difficulty by patients in prioritizing their top concerns. Primary care patients and their physicians adopt a range of different strategies to address the time constraints during visits. The primary factor that supported well-aligned visits was the ability for patients and physicians to proactively negotiate the visit agenda at the beginning of the visit. Efforts to optimize care within time-constrained systems should focus on helping patients more effectively prepare for visits. Physicians should ask for the patient's agenda early, explain visit parameters, establish a reasonable number of concerns that can be discussed, and collaborate on a plan to deal with concerns that cannot be addressed during the visit.

Reducing university students’ stress through a drop-in canine-therapy program

Background: Increasingly colleges and universities are offering canine therapy to help students de-stress as a means of supporting students’ emotional health and mental well-being. Despite the popularity of such programs, there remains a dearth of research attesting to their benefits.Aims: Participants included 1960 students at a mid-size western Canadian University. The study’s aims were to assess the stress-reducing effects of a weekly drop-in, canine-therapy program and to identify how long participants spent with therapy canines to reduce their stress.Methods: Demographic information was gathered, length of visit documented and a visual analog scale (VAS) was used to assess entry and exit self-reports of stress.Results: Participants’ self-reported stress levels were significantly lower after the canine therapy intervention. Participants spent an average of 35 min per session.Conclusions: This study supports the use of drop-in, canine therapy as a means of reducing university students’ stress. The findings hold applied significance for both counseling and animal therapy practitioners regarding the dose intervention participants seek to reduce their stress.

Plants, Polinators and Pests

It is well known that parasites and plants have complex intereactons. It is not well known how parasites may affect polinator preference. In the study I examined the plant Ox­Eye where it was with or without parasitic aphids. Different plant characteristics were measured as well as the amount of aphids on the plant. Number of polinator visits and visit length were recorded to indicate a polinator preference for each plant. The data suggests that although polinators visited the plants with aphids, they spent significantly more time on the plants without parasites. Pilot follow up studies were also performed. The experiment took place in the summer of 2006 at the Kellogg Bird Sanctuary, part of Michigan State University's Biological Field Station

Resources and organisation in primary health care are associated with HbA1c level: A nationwide study of 230 958 people with Type 2 diabetes mellitus

AimsTo examine the association between personnel resources and organisational features of primary health care centres (PHCCs) and individual HbA1c level in people with Type 2 diabetes mellitus (T2DM). MethodsPeople with T2DM attending 846 PHCCs (n=230958) were included in this cross-sectional study based on PHCC-level data from a questionnaire sent to PHCCs in 2013 and individual-level clinical data from 2013 for people with T2DM reported in the Swedish National Diabetes Register, linked to individual-level data on socio-economic status and comorbidities. Data were analysed using a generalized estimating equations linear regression models. ResultsAfter adjusting for PHCC- and individual-level confounding factors, personnel resources associated with lower individual HbA1c level were mean credits of diabetes-specific education among registered nurses (RNs) (−0.02mmol/mol for each additional credit; P<0.001) and length of regular visits to RNs (−0.19mmol/mol for each additional 15min; P<0.001). Organisational features associated with HbA1c level were having a diabetes team (−0.18mmol/mol; P<0.01) and providing group education (−0.20mmol/mol; P<0.01). ConclusionsIn this large sample, PHCC personnel resources and organisational features were associated with lower HbA1c level in people with T2DM.

A new marker of primary care utilization - annual accumulated duration of time of visits

BackgroundMost of the research on primary care workload has focused on the number of visits or the average duration of visits to a primary care physician (PCP) and their effect on the quality of medical care. However, the accumulated annual visit duration has yet to be examined. This measure could also have implications for the allocation of resources among health plans and across regions. In this study we aimed to define and characterize the concept of "Accumulated Annual Duration of Time" (AADT) spent with a PCP. MethodA cross-sectional study based on a national random sample of 77,247 adults aged 20 and over. The study’s variables included annual number of visits and AADT with a PCP, demographic characteristics and chronic diseases. The time period was the entire year of 2012.ResultsFor patients older than 20 years, the average annual number of visits to a PCP was 8.8 ± 9.1, and the median 6 ± 10 IQR (Interquartile Range). The mean AADT was 65.8 ± 75.7 min, and the median AADT was 43 ± 75 IQR minutes. The main characteristics of patients with a higher annual number of visits and a higher AADT with a PCP were: female, older in age, a higher Charlson index and a low socio-economic status. Chronic diseases were also found to increase the number of annual visits to a PCP as well as the AADT, patients with chronic heart failure had highest AADT in comparison to others (23.1 ± 15.5 vs. 8.6 ± 8.9 visits; and 165.3 ± 128.8 vs. 64.5 ± 74 min). It was also found that the relationship between AADT and age was very similar to the relationship between visits and age.ConclusionWhile facing the ongoing increase in a PCP’s work load and shortening of visit length, the concept of AADT provides a new measure to compare between different healthcare systems that allocate different time frames for a single primary care visit. For Israel, the analysis of the AADT data provides support for continued use of the number of visits in the capitation formula, as a reliable and readily-accessible indicator of primary care usage.

Patient priorities and the doorknob phenomenon in primary care: Can technology improve disclosure of patient stressors?

ObjectivePatients with multiple chronic conditions face many stressors (e.g. financial, safety, transportation stressors) that are rarely prioritized for discussion with the primary care provider (PCP). In this pilot randomized controlled trial we examined the effects of a novel technology-based intervention called Customized Care on stressor disclosure. MethodsThe main outcomes were stressor disclosure, patient confidence and activation, as assessed by self-report and observational methods (transcribed and coded audio-recordings of the office visit). ResultsSixty patients were enrolled. Compared with care as usual, intervention patients were 6 times more likely to disclose stressors to the PCP (OR=6.16, 95% CI [1.53, 24.81], p=0.011) and reported greater stressor disclosure confidence (exp[B]=1.06, 95% CI [1.01, 1.12], p=0.028). No differences were found in patient activation or the length of the office visit. ConclusionCustomized Care improved the likelihood of stressor disclosure without affecting the length of the PCP visit. Practice implicationsBrief technology-based interventions, like Customized Care could be made available through patient portals, or on smart phones, to prime patient-PCP discussion about difficult subjects, thereby improving the patient experience and efficiency of the visit.

Faculty Development for Medical School Community-Based Faculty: A Council of Academic Family Medicine Educational Research Alliance Study Exploring Institutional Requirements and Challenges.

Community-based faculty play a large role in training medical students nationwide and require faculty development. The authors hypothesized that positive relationships exist between clerkships paying preceptors and requiring faculty development, and between protected clerkship directors' time and delivering face-to-face preceptor training, as well as with the number or length of community-based preceptor visits. Through under standing the quantity, delivery methods, barriers, and institutional support for faculty development provided to community-based preceptors teaching in family medicine clerkships, best practices can be developed. Data from the 2015 Council of Academic Family Medicine's Educational Research Alliance survey of Family Medicine Clerkship Directors were analyzed. The cross-sectional survey of clerkship directors is distributed annually to institutional representatives of U.S. and Canadian accredited medical schools. Survey questions focused on the requirements, delivery methods, barriers, and institutional support available for providing faculty development to community-based preceptors. Paying community-based preceptors was positively correlated with requiring faculty development in family medicine clerkships. The greatest barrier to providing faculty development was community-based preceptor time availability; however, face-to-face methods remain the most common delivery strategy. Many family medicine clerkship directors perform informal or no needs assessment in developing faculty development topics for community-based faculty. Providing payment to community preceptors may allow schools to enhance faculty development program activities and effectiveness. Medical schools could benefit from constructing a formal curriculum for faculty development, including formal preceptor needs assessment and program evaluation. Clerkship directors may consider recruiting and retaining community-based faculty by employing innovative faculty development delivery methods.

Electronic Visits in Primary Care: Modeling, Analysis, and Scheduling Policies

Primary care, the backbone of the nation’s healthcare system, is at the risk of collapse. Patients are dissatisfied due to poor access to care, and physicians are unhappy and burning out with an enormous amount of tasks. To improve the primary care access, many healthcare organizations have introduced electronic visits (or e-visits) to provide patient-physician communications through securing messages. In this paper, we introduce an analytical model to study e-visits in primary care clinics. Analytical formulas to evaluate the mean and variance of the patient length of visit in primary care clinics with e-visits are derived. System properties are investigated. In addition, comparisons of different scheduling policies between the office and the e-visits are carried out. The first come first serve, preemptive-resume, and non-preemptive policies are studied and the results show that the first come first serve policy typically leads to the best performance. Note to Practitioners —The primary care delivery system is under a lot of strain. Due to population growth and aging, and the expanded healthcare insurance coverage, the demand for primary care services has increased substantially in the past years. Patients have difficulty of getting timely access to care, while primary care physicians are facing insurmountable tasks. Electronic visit, or e-visit, as an alternative to the traditional office visit, provides an innovative way of patient-physician communication through securing messages. The successful implementation of e-visit relies on a proper understanding of the impact of e-visit on care access, and an appropriate design and scheduling of workforce and operations. Therefore, the objective of this paper is to develop an analytical model of the primary care delivery with e-visits, using which one can investigate the impact of e-visits on patient accessibility. In particular, the average value and variance of patients’ length of visit for their encounters are evaluated. Different policies for physicians to schedule office and e-visit patients are compared. In addition, physicians’ nondirect care activities, such as billings and documentations, are also considered in the model.

Interactive home telehealth and burns: A pilot study

ObjectiveThe objective of this study is to review our experience incorporating Interactive Home Telehealth (IHT) visits into follow-up burn care. MethodsA retrospective review of all burn patients participating in IHT encounters over the course of 15 months was performed. Connections were established through secure video conferencing and call-routing software. Patients connected with a personal computer or tablet and providers connected with a desktop computer with a high-definition web camera. In some cases, high-definition digital images were emailed to the provider prior to the virtual consultation. For each patient, the following was collected: (1) patient and injury demographics (diagnosis, prognosis, and clinical management), (2) total number of encounters, (3) service for each encounter (burn, psychiatry, and rehabilitation), (4) length of visit, including travel distance and time saved and, (5) complications, including re-admissions and connectivity issues. Results52 virtual encounters were performed with 31 patients during the first year of the pilot project from March 2015 to June 2016. Mean age of the participant was 44 years (range 18–83 years). Mean total burn surface area of the participant was 12% (range 1–80%). Average roundtrip travel distance saved was 188 miles (range 4–822 miles). Average round trip travel time saved was 201min (range 20–564min). There were no unplanned re-admissions and no complications. Five connectivity issues were reported, none of which prevented completion of the visit. ConclusionsInteractive Home Telehealth is a safe and feasible modality for delivering follow-up care to burn patients. Burn care providers benefit from the potential to improve outpatient clinic utilization. Patients benefit from improved access to multiple members of their specialized burn care team, as well as cost-reductions for patient travel expenses. Future studies are needed to ensure patient and provider satisfaction and to further validate the significance, cost-effectiveness and safety.

How do reinforcers affect choice? Preference pulses after responses and reinforcers.

In concurrent schedules, reinforcers are often followed by a brief period of heightened preference for the just-productive alternative. Such 'preference pulses' may reflect local effects of reinforcers on choice. However, similar pulses may occur after nonreinforced responses, suggesting that pulses after reinforcers are partly unrelated to reinforcer effects. McLean, Grace, Pitts, and Hughes (2014) recommended subtracting preference pulses after responses from preference pulses after reinforcers, to construct residual pulses that represent only reinforcer effects. Thus, a reanalysis of existing choice data is necessary to determine whether changes in choice after reinforcers in previous experiments were actually related to reinforcers. In the present paper, we reanalyzed data from choice experiments in which reinforcers served different functions. We compared local choice, mean visit length, and visit-length distributions after reinforcers and after nonreinforced responses. Our reanalysis demonstrated the utility of McLean et al.'s preference-pulse correction for determining the effects of reinforcers on choice. However, visit analyses revealed that residual pulses may not accurately represent reinforcer effects, and reinforcer effects were clearer in visit analyses than in local-choice analyses. The best way to determine the effects of reinforcers on choice may be to conduct visit analyses in addition to local-choice analyses.

Assessment of reimbursement in a community hospital-based pharmacist-managed outpatient transition clinic.

The assessment of reimbursement for and time spent on patient visits in a newly implemented, outpatient pharmacist-managed transition clinic (TC) was studied. A retrospective chart review was conducted on clinic visits that occurred during January 1 to December 31, 2015. Patients who had at least one TC visit during the study period were included. Any visit with no response from insurance by March 31, 2016, was excluded. Services provided by the TC were billed using a facility fee billing model. The following data were collected: number of visits, time length of individual visits, billed amount, level of service, type of insurance, and amount reimbursed (from primary insurance, secondary insurance, and total amount). Data were analyzed using descriptive statistics. One hundred eight patients were eligible for inclusion in the study, with a total of 306 eligible visits. Each patient had a mean of 2.82 visits. The mean ± S.D. time spent per visit was 55 minutes. Visits were billed at level 2 (2%), level 3 (36%), and level 4 (62%). Two hundred seventy-two visits (89%) were partially or completely reimbursed by insurance, whereas 34 visits (11%) provided no reimbursement. The mean ± S.D. reimbursement was $99 ± $51.88 per visit. A pharmacist-managed TC service based in a community hospital achieved a positive return on investment through insurer reimbursement over a 12-month period.

Impact of measuring quality of life in oncology practice: A prospective study.

e21663 Background: To assess the impact of incorporating systematic quality of life measurements in oncology practice on the quality of care and well-being of patients; to assess physician's level of satisfaction with this instrument and detectable changes in clinical practice Methods: In a prospective study, 67 patients (pts) diagnosed with cancer, undergoing cancer-specific treatments, were randomized into a intervention and control group. In the intervention group , pts had regular completion of touch-screen health-related quality of life (HRQL) questionnaires (European Organization for Research and Treatment of Cancer–Core Quality of Life Questionnaire version 3.0, and Hospital Anxiety and Depression Scale) and feedback of results to physician and then were followed up with a phone call where HRQL was measured by the Functional Assessment of Cancer Therapy–General questionnaire (FACT-G). In the control group, pts were regular followed with a phone call to answer FACT-G questionnaire. Physicians completed a visit-specific questionnaire after each visit of pts from intervention group. Results: 58 pts were included, 36 in the intervention group and 22 in the control group. Median age was 59 years. The results of the patient-reported data were found to be very useful to quite useful by 87.5% of physicians (14/16), and 56.3% of them considered that there was no difference in the length of visits. Completing the HRQL questionnaires on a touch screen was easy to very easy for 97.1% of patients, and 97.1% found that important questions were asked and that they would be willing to complete the questionnaires. FACT-G scores and subscale scores were higher in the intervention group, but differences were not statistically significant (76.44 v 72.60; p 0.388). Conclusions: HRQL assessments had a positive impact on physician-patient communication. It made it possible to learn how cancer and its treatments affected pts not only physically, but also on functional and psychological states and social relationships. They helped us improve therapeutic interventions and specialist referrals, thus achieving positive changes in the well-being and satisfaction of pts.

Frequency Vs. Length of Hot Spots Patrols: a Randomised Controlled Trial

Research QuestionDo shorter but more frequent patrol visits to the same crime hot spots reduce daily crime and anti-social behaviour (ASB) totals more effectively than less frequent but longer patrols, if the total time that police are present each day is held roughly constant?DataGPS measures from patrol officer body-worn radios tracked the time each officer spent within seven geo-fenced crime “hot spots” of 150 × 150 m, summing the number of both individual officer-minutes and patrol-minutes (with one or more officers present simultaneously) per day per hot spot, as well as number of visits and minutes per visit. Activity reports were used to detect the simultaneous presence of more than one officer, yielding the key independent variables of number and length of patrol visits in which one or more police officers were present. The dependent variable was total reports of crime and anti-social behaviour (ASB) identified within the hot spot boundaries each day of the experiment.MethodAll seven hot spots of crime and ASB were randomly allocated each day to one of two patrol duration conditions for a period of 100 days (43 “short” visit days and 57 “long” visit days) between June and November 2015, with patrol time measures reported back to officers on the number and length of patrols conducted daily. The long visit model required three visits daily of 15 min duration each; the short visit model required nine visits daily of 5 min each. On all days, a target of 45 min of total patrol time was required.ResultsActual patrol delivery measured by GPS and activity reports produced a mean of just over 24 patrol-minutes (of one or more officers present) on “long” days and just under 26 min on “short” days, so that dosage was approximately held constant to test the independent effect of more or fewer visits. The treatment as delivered on “long” days was a mean of 2.5 visits averaging 9.6 min each; on “short” days, the same officers delivered a mean of 5 visits averaging 5.2 min each. The less-frequent long visit model was more effective than the more-frequent short visit model, with mean counts of crime and ASB incidents 19.51% lower on long visit days =0.697 incidents per day compared to 0.561 incidents per day on short visit days (d = −0.175; p = 0.018).ConclusionControlling for the total patrol time spent at a hot spot each day, the difference between 2.5 longer visits and 5 shorter visits causes about 20% less crime when longer visits are delivered. These findings of the deterrent effect of increasing patrol visit length by 85% are consistent with Koper’s (1995) correlational observation that longer units of 10–15 min duration appeared optimal in creating a residual deterrent effect at a hot spot immediately after police leave the vicinity. Although this study cannot distinguish between crime reductions immediately after vs. long after police have left the scene, this is the first experiment to randomly assign a substantial difference (twice as many) in the number of visits daily to a hot spot, with almost twice as much time per visit when fewer visits are made. The use of random assignment of two different patrol models with the same total time in the same seven geographic units gives great confidence that using that time in fewer visits of longer duration causes less crime and anti-social behaviour than more visits of shorter duration.