Daniel Jonathan Kagedan1, Stephen B Edge1,2, Kazuaki Takabe3,4,5. 1. Department of Surgical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA. 2. Jacobs School of Medicine and Biomedical Sciences, University of Buffalo, Buffalo, NY, USA. 3. Department of Surgical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA. Kazuaki.Takabe@RoswellPark.org. 4. Jacobs School of Medicine and Biomedical Sciences, University of Buffalo, Buffalo, NY, USA. Kazuaki.Takabe@RoswellPark.org. 5. Roswell Park Comprehensive Cancer Center, Clinical Sciences Center, Room P-615 Elm and Carlton Streets, 14263, Buffalo, NY, USA. Kazuaki.Takabe@RoswellPark.org.
Abstract
BACKGROUND: Longer wait time in ambulatory clinics can disrupt schedules and decrease satisfaction. We investigated factors associated with patient wait time (WT, check-in to examination room placement), approximate clinician time (ACT, completion of nurse assessment to check-out), and total appointment length (TAL, check-in to check-out). METHODS: A single-institution retrospective study was conducted of breast surgery clinic patients, 2017-2019, using actual encounter times. A before/after analysis compared a five-day 8 hour/day (from a four-day 10 hour/day) advanced practice provider (APP) work-week. Non-parametric tests were used, and medians with interquartile ranges (IQRs) reported. RESULTS: 15,265 encounters were identified. Overall WT was 15.0 minutes (IQR:6.0-32.0), ACT 49.0 minutes (IQR:31.0-79.0) and TAL 84.0 minutes (IQR:57.0-124.0). Trainees were associated with 30.0 minutes longer ACT (p < 0.0001); this increased time was greatest for follow-up appointments, least for new patients. Patients arriving > 5 minutes late (versus on-time) experienced shorter WT (11.0 vs. 15.0 minutes, p < 0.0001) and ACT (43.0 vs. 53.0 minutes, p < 0.0001). Busier days (higher encounter volume:APP ratios) demonstrated increased encounter times. After transitioning to a five-day APP work-week, ACT decreased. CONCLUSIONS: High-volume clinics and trainee involvement prolong ambulatory encounters. Increasing APP assistance, altering work schedules, and assigning follow-up appointments to non-trainees may decrease encounter time.
BACKGROUND: Longer wait time in ambulatory clinics can disrupt schedules and decrease satisfaction. We investigated factors associated with patient wait time (WT, check-in to examination room placement), approximate clinician time (ACT, completion of nurse assessment to check-out), and total appointment length (TAL, check-in to check-out). METHODS: A single-institution retrospective study was conducted of breast surgery clinic patients, 2017-2019, using actual encounter times. A before/after analysis compared a five-day 8 hour/day (from a four-day 10 hour/day) advanced practice provider (APP) work-week. Non-parametric tests were used, and medians with interquartile ranges (IQRs) reported. RESULTS: 15,265 encounters were identified. Overall WT was 15.0 minutes (IQR:6.0-32.0), ACT 49.0 minutes (IQR:31.0-79.0) and TAL 84.0 minutes (IQR:57.0-124.0). Trainees were associated with 30.0 minutes longer ACT (p < 0.0001); this increased time was greatest for follow-up appointments, least for new patients. Patients arriving > 5 minutes late (versus on-time) experienced shorter WT (11.0 vs. 15.0 minutes, p < 0.0001) and ACT (43.0 vs. 53.0 minutes, p < 0.0001). Busier days (higher encounter volume:APP ratios) demonstrated increased encounter times. After transitioning to a five-day APP work-week, ACT decreased. CONCLUSIONS: High-volume clinics and trainee involvement prolong ambulatory encounters. Increasing APP assistance, altering work schedules, and assigning follow-up appointments to non-trainees may decrease encounter time.
Entities:
Keywords:
Ambulatory care; Breast cancer; Breast surgery; Surgical training; Time factors
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