Waiting Room Time Research Articles

Examining the Association between Community-Level Marginalization and Emergency Room Wait Time in Ontario, Canada.

Objective:This study examines the association between community-level marginalization and emergency room (ER) wait time in Ontario.Methods:Data sources included ER wait time data and Ontario Marginalization Index scores. Linear regression models were used to quantify the association.Results:A positive association between total marginalization and overall, high-acuity and low-acuity ER wait time was found. Considering specific marginalization dimensions, we found positive associations between residential instability and ER wait time and negative associations between dependency and ER wait time.Conclusions:Reductions in community-level marginalization may impact ER wait time. Future studies using individual-level data are necessary.

The impact of hospital boarding on the emergency department waiting room.

BackgroundPatient boarding in the emergency department (ED) is a significant issue leading to increased morbidity/mortality, longer lengths of stay, and higher hospital costs. We examined the impact of boarding patients on the ED waiting room. Additionally, we determined whether facility type, patient acuity, time of day, or hospital occupancy impacted waiting rooms in 18 EDs across a large healthcare system.MethodsThis was a retrospective multicenter study that included all ED encounters between January 1, 2018, and September 30, 2019. Encounters with missing Emergency Severity Index (ESI) level were excluded. ESI levels were defined as high (ESI 1,2), middle (ESI 3), and low (ESI 4,5). Spearman correlation coefficients measured the relationship between boarded patients and number of patients in ED waiting room. A multivariable mixed effects model identified drivers of this relationship.ResultsA total of 1,134,178 encounters were included. Spearman correlation coefficient was significant between number of patients in the ED waiting room and patient boarding (0.54). For every additional patient boarded/hour, the number of patients waiting/hour in the waiting room increased by 8% (95% confidence interval [CI] = 1.08–1.09). The number of patients waiting for a room/hour was 2.28 times higher for middle than for high acuity. The number of patients in waiting room slightly decreased as hospital occupancy increased (95% CI = 0.997–0.997).ConclusionNumber of patients in ED waiting room are directly related to boarding times and hospital occupancy. ED waiting room times should be considered as not just an ED operational issue, but an aspect of hospital throughput.

COVID-19 Moves Medicine into a Virtual Space: A Paradigm Shift From Touch to Talk to Establish Trust.

COVID-19 Moves Medicine into a Virtual Space: A Paradigm Shift From Touch to Talk to Establish Trust.

Enabling effective oversight: Enterprise risk management and board governance in healthcare.

Lengthy emergency room wait times leaving patients waiting for essential care. Dwindling annual budgets putting core services at risk. Cyberattacks resulting in ransomed data. These are just some of the ever-present risks in the healthcare sector. Each of these risks has a potential for high likelihood of occurrence, impact, and velocity. Identifying, assessing, mitigating, and reporting risk are therefore crucial to Enterprise Risk Management (ERM), and should be built into healthcare institutional processes. This column provides some recommendations for health leaders on how to enable effective oversight through ERM.

Demand and Capacity Modelling in Healthcare Using Discrete Event Simulation

The NHS is right now confronting huge pressures relating to demand and capacity in radiology. The purpose of this research has been to provide information about MRI usage, details of operational aspects of MRI services, and to ascertain the planning intentions of NHS radiology services to keep up and create MRI capacity. The report expands on using Discrete Event Simulation (DES) to inspect and plan the utilisation of NHS hospital resources for the radiology department to help a 24 hr service that is available to outpatients which will help with diminishing patient waiting time, better resource usage, understanding the capacity and demand. Consequently, this research examines to adjust staff and resources with the demand of the MRI. The research was investigated using DES in various scenarios to find which resources are inactive; patients are treated slowly. DES helped in discovering resource utilisation and outpatient throughout the system. It additionally helped in distinguishing the bottlenecks in patient flow. The DES simulation results demonstrated that time for the outpatient in the system is less and more outpatients have been treated too. There is a higher level of outpatient patients leaving the system under 120 minutes. The report uncovered an MRI report interpretation time. Reception room time and MRI waiting room time are decreased significantly. It additionally exhibited with an expanded outflow of outpatients, resources, for example, MRI capacity and radiographer utilisation expanded.

Response: Re: A Successful Walk-In Psychiatric Model for Integrated Care

To the Editor: Dr. Brinn[1][1] is right to point out that that the walk-in psychiatry model we developed at Brigham Health[2][2] fails to manage waiting room times in a way that proactively engages patients who might otherwise leave before receiving treatment. A trade-off was made between risking

Modeling Emergency Room Arrivals Using the Poisson Process

Flashy billboards advertising emergency room wait times are prominent along many roads in the US. These signs are just one way hospitals aim to stay competitive in a growing market. However, one mi...

P78. The true penalty of the waiting room: the role of wait time in patient satisfaction in a busy spine practice

BACKGROUND CONTEXT Most clinics collect routine data on performance metrics on physicians for outpatient visits. However, the relationship between them and the patient experience is vague. PURPOSE The aim of this study was to investigate the relationships between the Consumer Assessment of Healthcare Providers and Systems Clinician and Group Survey (CG-CAHPS), the current standard evaluation of the patient experience, and new performance metrics we collected in order to understand the determinants of patient satisfaction and identify targets for improving the patient experience. STUDY DESIGN/SETTING Retrospective cohort study, single academic health system. OUTCOME MEASURES CG-CAHPS scores in 3 domains – global, access and communication. METHODS All spine surgeons in our academic health system were included and the following were retrospectively reviewed from a 15-month period: demographic data, average cycle times (time in minutes from check-in to check-out), waiting-room times (check-in to being roomed), in-room times (room placement to check-out), lead times (time in days from scheduling phone call to appointment), timely note closure, timely response to patient questions and patient volume (number of new and total patients per month). Kruskal Wallis tests and univariate and multivariate mixed model regression were used to determine the relationships between these covariates and the patient-reported outcomes as measured by CG-CAHPS in 3 domains – global, access and communication. RESULTS Twenty-two surgeons were included in the study. There were 27,090 visits. Male gender and no fellowship were independently associated with higher satisfaction in global ratings (p CONCLUSIONS Excessive waiting room time affects not only access scores but also significantly colors other dimensions of the patient experience and impacts perceived communication between patients and doctors. Understanding the complex relationship between the factors that inform the patient experience will help to target effective interventions to improve clinic efficiency and patient satisfaction. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

Left without being seen in a hybrid point of service collection model emergency department

ObjectiveThis study identifies reasons and predictors of LWBS and examines outcomes of patients in a model that uses “point-of-service” (POS) collection for low acuity patients. MethodsThis was a matched case-control study of all patients who left without being seen from the ED of a tertiary care center in Beirut Lebanon between June 2016 and May 2017. Matching was done for the ESI score, date and time (±2 h). A descriptive analysis and a bivariate analysis were conducted comparing patients who LWBS and those who completed their medical treatment. This was followed by a Logistic regression to identify predictors of LWBS. Results133 LWBS cases and 133 matched controls were enrolled in the study. Mean age for LWBS patients was (31.69 ± 15.29). The average reported wait time of LWBS patients was reported as 27.48 min (±25.09). Reasons for LWBS were; non-compensable status (66.9%), financial reasons (12.8%), long waiting times (12.8%), and others (8.3%). The majority of LWBS patients (81.2%) sought medical care after leaving the ED, and 8.3% of the LWBS patients represented to the ED after 48 h. Important predictors of LWBS included male gender, lower than undergraduate education level, waiting room time, non-compensable coverage status and fewer ED visits in the past year. ConclusionIn an ED setting with POS collection for low acuity patients, non-compensable coverage status was the strongest predictor for LWBS. Further studies are needed to assess the outcomes of patients who LWBS in this model of care.

LEAN SIX SIGMA TECHNIQUES TO IMPROVE OPHTHALMOLOGY CLINIC EFFICIENCY.

Ophthalmologists serve an increasing volume of a growing elderly population undergoing increasingly complex outpatient medical care, including extensive diagnostic testing and treatment. The resulting prolonged patient visit times ("patient flow times") limit quality, patient and employee satisfaction, and represent waste. Lean Six Sigma process improvement was used in a vitreoretinal practice to decrease patient flow time, demonstrating that this approach can yield significant improvement in health care. Process flow maps were created to determine the most common care pathways within clinic. Three months' visits from the electronic medical record system, which tracks patient task times at each process step in the office were collected. Care tasks and care pathways consuming the greatest time and variation were identified and modified. Follow-up analysis from 6 weeks' visits was conducted to assess improvement. Nearly all patients took one of five paths through the office. Patient flow was redesigned to reduce waiting room time by having staff members immediately start patients into one of those five paths; staffing was adjusted to address high demand tasks, and scheduling was optimized around derived predictors of patient flow times. Follow-up analysis revealed a statistically significant decline in mean patient flow time by 18% and inpatient flow time SD by 4.6%. Patient and employee satisfaction scores improved. Manufacturing industry techniques, such as Lean and Six Sigma, can be used to improve patient care, minimize waste, and enhance patient and staff satisfaction in outpatient clinics.

Increasing Patient Satisfaction by Decreasing Waiting Room Times

Several research studies have linked the time patients must spend in the waiting room to patient dissatisfaction. This became a concern at an intercity pediatric outpatient surgery center after reviewing surveys and listening to patient/ family comments. In the initial review of waiting room times, this surgery center had 40% of their patients waiting over ten minutes after they were registered for surgery.

Clinical, operational, and financial impact of an ultraviolet-C terminal disinfection intervention at a community hospital

Hospital-acquired infections (HAIs) are a significant contributor to adverse patient outcomes and excess cost of inpatient care. Adjunct ultraviolet-C (UV-C) disinfection may be a viable strategy for reducing HAIs. This study aimed to measure the clinical, operational, and financial impact of a UV-C terminal disinfection intervention in a community hospital setting. Using a pre-post study design, we compared the HAI rates of 5 multidrug-resistant bacteria (Acinetobacter baumannii, Klebsiella pneumoniae, methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococcus, and Pseudomonas aeruginosa) from 6 culture sites before and after a 12-month facility-wide UV-C intervention. To measure impact of UV-C disinfection on hospital operations, mean inpatient emergency room wait time was calculated. Finally, we conducted a cost saving analysis to evaluate the financial benefits of the intervention. Overall, 245 HAIs among 13,177 inpatients were observed during a 12-month intervention period, with an incidence rate of 3.94 per 1,000 patient days. This observed HAIs incidence was 19.2% lower than the preintervention period (4.87 vs 3.94 per 1,000 patient days; P = .006). The intervention did not adversely impact emergency department admissions (297.9 vs 296.2 minutes; P = .18) and generated a direct cost savings of $1,219,878 over a 12-month period. The UV-C disinfection intervention was associated with a statistically significant facility-wide reduction of multidrug-resistant HAIs and generated substantial direct cost savings without adversely impacting hospital operations.

Comparing the Effect of Throughput and Output Factors on Emergency Department Crowding: A Retrospective Observational Cohort Study

This study compares how throughput and output factors affect emergency department (ED) median waiting room time. Administrative health care use records were used to identify all daytime (8 am to 8 pm) visits made to adult EDs in Winnipeg, Canada, between April 1, 2012, and March 31, 2013. First, we measured the waiting room time (from patient registration until transfer into the ED) of each index visit (incoming patient). We then linked each index visit to a group of existing patients surrounding it and counted the number of existing patients engaged in throughput processes (radiographs, computed tomography [CT] scans, advanced diagnostic tests) and one output process (waiting to be hospitalized). Regression analysis was used to measure how strongly each factor uniquely affected incoming patient median waiting room time, stratified by the acuity level. Analyses were performed on 143,172 index visits. On average, 153.4 radiographs and 48.5 CT scans were conducted daily, whereas 45.3 patients were admitted daily to hospital. Median waiting room time was shortest (8.0minutes) for the highest-acuity index visits and was not influenced by these throughput or output factors. For all other index visits, median waiting room time was associated strongly with the number of existing patients receiving radiographs, and, to a lesser extent, with the number of existing patients receiving CT scans and waiting for hospital admission. Both throughput and output factors affect how long newly arriving ED patients remain in the waiting room. This suggests that a range of strategies may help to reduce ED wait time, each requiring stronger ED and hospital partnerships.

Injury Prevention Education in the Waiting Room of an Urban, Underserved Pediatric Primary Care Clinic

Purpose: Unintentional injuries are the leading cause of death for children greater than 1 year of age and can be prevented with appropriate education. However, physicians may not be comfortable or have enough time during the visit to discuss injury prevention. We chose this setting because previous studies have illustrated that utilizing the time in the waiting room to provide education yields positive results. There are two main purposes of this study. The first is to provide injury prevention education that is accessible to caregivers outside of the well-child visit. The second is to improve patient satisfaction by creating a waiting room atmosphere that is educational …

Increased burden on metropolitan urological services: The era of the Australian National Emergency Access Targets (NEAT or the "4-h target").

Background:The National Emergency Access Targets (NEAT) was introduced in Australia in 2011 and guides the clearance of presentations within 4-h of initial presentation from the Emergency Department (ED). We aim to assess the impact of the introduction of NEAT on acute urological services at a large metropolitan center.Methods:A retrospective cohort study was performed and data were collected from electronic patient management systems. The control group was represented by ED presentations between June and September 2011, 1 year prior to the introduction of NEAT. The two study groups consisted of ED presentations between June and September 2012 and 2013, respectively. Outcome measures included time to the ureteric stent and scrotal exploration, inpatient length of stay (IPLOS), out-of-hours operating, and hospital mortality rates.Results:Across the three study periods, a total of 76,935 patients were assessed by the EDs of the health service. 225 urological inpatient episodes were included across all periods with a trend showing increasing numbers of admissions (P = 0.003). For patients admitted under the urological service: Waiting room time and ED length of stay decreased significantly (P < 0.001). Proportion of operative cases decreased insignificantly (P = 0.275). Time from emergency presentation to emergency ureteric stent remained unchanged, however, proportions of procedures performed out-of-hours showed an increasing trend (P < 0.001). A significant increase in inter-unit transfer was observed, however, median IPLOS and mortality for operative and nonoperative cases remain unchanged.Conclusions:Concerning urological admissions, the implementation of NEAT has been associated with improvement in ED key performance indicators. Such changes have been correlated with reductions in operative cases and increases in out-of-hours emergency operating. Further research is required to evaluate the direct effect of NEAT on urological patient care.

Factors Influencing Patient Selection of a Foot and Ankle Surgeon.

Level III: Prospective questionnaire.

Factors Influencing Patient Selection of an Orthopaedic Sports Medicine Physician.

Background:The rise in consumer-centric health insurance plans has increased the importance of the patient in choosing a provider. There is a paucity of studies that examine how patients select an orthopaedic sports medicine physician.Purpose:To evaluate factors that patients consider when choosing an orthopaedic sports medicine physician.Study Design:Case series; Level of evidence, 4.Methods:A total of 1077 patients who sought treatment by 3 sports medicine physicians were administered an anonymous questionnaire. The questionnaire included 19 questions asking respondents to rate the importance of specific factors regarding the selection of orthopaedic sports medicine physicians on a scale of 1 (not important at all) to 10 (very important). The remaining 6 questions were multiple-choice and regarded the following criteria: preferred physician age, appointment availability, clinic waiting room times, travel distance, and medical student/resident involvement.Results:Of the 1077 consecutive patients administered the survey, 382 (35%) responded. Of these, 59% (n = 224) were male, and 41% (n = 158) were female. In ranking the 19 criteria in terms of importance, patients rated board certification (9.12 ± 1.88), being well known for a specific area of expertise (8.27 ± 2.39), and in-network provider status (8.13 ± 2.94) as the 3 most important factors in selecting an orthopaedic sports medicine physician. Radio, television, and Internet advertisements were rated the least important. Regarding physician age, 63% of patients would consider seeking a physician who is ≤65 years old. Approximately 78% of patients would consider seeking a different physician if no appointments were available within 4 weeks.Conclusion:The study results suggest that board certification, being well known for a specific area of expertise, and health insurance in-network providers may be the most important factors influencing patient selection of an orthopaedic sports medicine physician. Advertisements were least important to patients. Patient preferences varied regarding ideal physician age, clinic appointment availability, medical student/resident involvement, and travel distance in choosing an orthopaedic sports medicine physician. In the context of health care delivery and as reimbursement becomes increasingly consumer centered, understanding the process of provider selection is important.

Triaging the Emergency Department, Not the Patient: United States Emergency Nurses’ Experience of the Triage Process

IntroductionTriage, as it is understood in the context of the emergency department, is the first and perhaps the most formal stage of the initial patient encounter. Bottlenecks during intake and long waiting room times have been linked to higher rates of patients leaving without being seen. The solution in many emergency departments has been to collect less information at triage or use an “immediate bedding” or “pull until full” approach, in which patients are placed in treatment areas as they become available without previous screening. The purpose of this study was to explore emergency nurses’ understanding of—and experience with—the triage process, and to identify facilitators and barriers to accurate acuity assignation. MethodsAn exploratory qualitative study using focus-group interviews (N = 26). ResultsFive themes were identified: (1) “Sick or not sick,” (2) “Competency/qualifications,” (3) “Triaging the emergency department, not the patient,” (4) “The unexpected,” and (5) “Barriers and facilitators.” DiscussionOur participants described processes that were unit- and/or nurse-dependent and were manipulations of the triage system to “fix” problems in ED flow, rather than a standard application of a triage system. Our participants reported that, in practice, the use of triage scales to determine acuity and route patients to appropriate resources varies in accuracy and application among emergency nurses and in their respective emergency departments. Nurses in this sample reported a prevalence of “quick look” triage approaches that do not rely on physiologic data to make acuity decisions. Future research should focus on intervention and comparison studies examining the effect of staffing, nurse experience, hospital policies, and length of shift on the accuracy of triage decision making.Contribution to Emergency Nursing Practice•This study explored the experience and understanding of triage as a nursing process in emergency settings.•Application of these findings may include the following:•A better understanding of how environmental constraints affect the decision-making capabilities of emergency nurses•Clear metrics and assessment mechanisms for triage competencies

Sports Medicine Physician Selection Criteria: Factors Influencing Patient Choice

Objectives:The rise in consumer-driven health insurance plans has increased the role of the patient in provider selection. The purpose of the present study is to identify factors that may influence a patient’s criteria for selecting his or her sports medicine physician.Methods:A total of 1077 patients who sought treatment by three sports medicine physicians were administered an anonymous questionnaire. Of these, 382 patients (35%) completed the survey. Response rates for each survey question ranged between 98% and 100%. The first part of the questionnaire consisted of 3 questions regarding demographic information. The second portion of the questionnaire consisted of 25 questions regarding provider selection. Of these, 19 questions asked respondents to rate the importance of specific criteria for the purposes of sports medicine physician selection on a scale of 1 to 10, with 10 being the most important. The remaining 6 questions were multiple-choice questions regarding the following criteria: the importance of physician age, appointment availability, clinic waiting room times, travel distance, and medical student/resident involvement.Results:Of the 382 respondents, 59% (n=224) were male and 41% (158) female. Regarding age, 29% (112) of respondents were under 35 years, 63% (234) between age 35 and 65 years, and 8% (35) were over 65 years. The majority of patients (89%) reported that 30 minutes or less should pass between check-in and seeing their physician during a clinic appointment. Most patients expressed no preference regarding resident (71%) or medical student (68%) involvement in their care. Regarding physician age, 63% of patients would consider seeking a physician who is younger than 65 years. Approximately 78% of patients would consider seeking a different physician if no appointments were available within 4 weeks. The ranking of the 19 criteria in terms of importance to patients are listed in Table 1. Patients rated board certification (9.12 ± 1.88), being “well-known” for a specific area of expertise (8.27 ± 2.39), and in-network provider status (8.13 ± 2.94) as the three most important factors in selecting a sports medicine physician. Radio, television, and internet advertisement were rated by patients as the least important factors in sports medicine physician selection.Conclusion:Our findings suggest that board certification, being “well-known” for a specific area of expertise, and in-network health insurance plans may be the most important factors influencing patients’ criteria for sports medicine physician selection. Radio, television, and internet advertisements were the least important criteria considered by patients. Patients expressed varying preferences regarding the ideal physician age, medical student/resident involvement, and clinic appointment availability when choosing a sports medicine physician. In the context of the increasing role of patients in health decision-making and provider selection, understanding the factors that influence patients’ selection of a sports medicine physician is important. Table 1.Ranking of Nineteen Sports Medicine Physician Selection Criteria According to the Results of the Anonymous Questionnaire Completed by Patients†RankScoreSports Medicine Physician Selection Criterion19.12 ± 1.88Board-certified28.27 ± 2.39“Well-known” for specific area of expertise38.13 ± 2.94Within insurance network48.10 ± 2.28Friendliness and bedside manner57.75 ± 2.58On-site imaging equipment available67.36 ± 2.40Appearance/Atmosphere of clinic facilities76.89 ± 3.10Recommendation by family member or friend86.23 ± 3.20Location of medical school, residency, and fellowship96.02 ± 3.08Actively involved in media research105.98 ± 3.19Positive online review (e.g. healthgrades.com, yelp.com, ratemd.com, etc)115.95 ± 3.00Receiving additional information (e.g. pamphlets, internet resources)125.83 ± 3.16Negative online review (e.g. healthgrades.com, yelp.com, ratemd.com, etc)135.61 ± 3.37Referral from primary care doctor or other physician144.75 ± 3.22Affiliation with professional sports team154.48 ± 3.17On-site physical therapy facilities available164.36 ± 2.86Size of the practice group172.29 ± 2.23Radio advertisement182.28 ± 2.25Internet advertisement192.17 ± 2.09TV advertisement† Patient responses were recorded with range of values between 1= Not important at all to 10= Very important; Represented by Mean ± Standard Deviation(n).

Waiting room time: An opportunity for parental oral health education.

The UBC Children's Dental Program (CDP) has provided free dental treatments to underserved low-income children, but its preventive component needs to be enhanced. The study aims were: 1) to develop a "waiting-room based" dental education program engaging caregivers of these children, and 2) to assess the program's feasibility, acceptability and effectiveness. In preparation, a situational analysis (SA) included structured interviews with caregivers, and with various stakeholders (e.g., dental students, instructors, health authority) involved in the CDP program. Based on the SA, caregiver-centered education was designed using an interactive power point presentation; after the presentation, each caregiver set personalized goals for modifying his/her child's dental behaviours. Evaluation of the program was done with follow-up telephone calls; the program's effectiveness was assessed by comparing before/after proportions of caregivers brushing their child's teeth, children brushing teeth in the morning and evening, children eating sugar-containing snacks, and children drinking sugar-containing drinks. The program proved to be easy to implement (feasible) and the recruitment rate was 99% (acceptable). The follow-up rate was 81%. The SA identified that the caregivers' knowledge about caries etiology and prevention was limited. All recruited caregivers completed the educational session and set goals for their family. The evaluation demonstrated an increase in caregiver-reported short-term diet and oral self-care behaviours of their children. A dental education program engaging caregivers in the waiting room was a feasible, acceptable and promising strategy for improving short-term dental behaviours of children.