Abstract
Introduction: We present a conceptual framework for approaching reducing excessive patient wait time in an outpatientsetting. We hypothesized that statistical process control techniques can be used to identify extremes in waiting time; root causeanalysis can be used to identify specific delay causes; and minimizing the contribution of the root causes will lead to an improvement insystem performance.
Subject and Method: We conducted a prospective study of waiting times in a private outpatient clinicproviding high-risk obstetrical care. The baseline period consisted of 55 clinic sessions, and the intervention period consisted of 101clinic sessions.
Results: Mean waiting time was prolonged during 9 (16.4%) baseline clinic sessions. The root causeanalysis determined that appointment schedule, physician tardiness, and patient complexity contributed to clinic delays. After makingchanges to minimize root causes, there was a significant reduction in prolonged waiting times (16.4% vs 4.9%, Yates[chi]2 = 4.37, P = .037); a significant decrease in mean waiting time (32.7 +/- 23.6 minutes vs29.3 +/- 21.2 minutes, t = 3.42, P < .001); and a significant improvement in the waiting timedistribution (Kruskal-Wallis test of homogeneity, P = .003).
Conclusions: Our methodology was successfulin identifying and reducing factors associated with prolonged wait times. However, although system operation was improved, as defined bya decrease in the occurrence of excessive clinic delays, effecting a large and sustained decrease in patient waiting times waschallenging.