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N. N. Shah, S. Agarwal, M. A. Desai; Patient Waiting Times in an Academic Urban versus Suburban Ophthalmology Clinic. Invest. Ophthalmol. Vis. Sci. 2010;51(13):3248.
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To determine factors for delay in urban and suburban ophthalmology clinics at Boston Medical Center. As waiting time (WT) is a significant barrier to follow-up care, this analysis aims to identify modifiable factors in unnecessary WT.
A time-flow sheet documenting key points during a patient visit (e.g. registration time, time patient seen by MD) and notation of delay factors (e.g. physical disability, need for interpreter) was placed in the patient chart and populated by technicians, residents, and attendings. Flow sheets were collected and tabulated to calculate prevalence of delay factors and time values including total WT. Data was analyzed using descriptive statistics and two-tailed unpaired t-tests. IRB exemption was obtained prior to conducting the study as the time-flow sheets contain no patient identifiers.
255 urban and 260 suburban patient encounters were examined. Total WT averaged 55 minutes during urban visits versus 39 minutes during suburban visits (P < .0001). Average total appointment time for urban encounters was 85 minutes versus 70 minutes for suburban appointments (P < .0001). Potential delays during urban clinic visits included: 14.9% language interpretation, 9% patient physical disability, 1.6% shortage of lanes, 1.6% shortage of equipment, and 11.4% "other" sources. The most common "other" delay was a missing chart. Suburban sources of delay included: 0.8% language interpretation, 4.6% patient physical disability, and 3.9% "other" sources. Residents were involved in 14.1% of urban and 0% of suburban visits.
Patients experienced increased waiting and overall appointment times at the urban clinics as compared to suburban clinics. This may be explained by delays due to interpretation requirements, shortage of lanes, shortage of equipment, patient physical disability, loss of paper charts, and resident participation. The WT may potentially be reduced by increasing availability of interpreter services, lanes, and equipment; improving access for disabled patients; and implementing an electronic medical records system. Scheduling patterns may also play a significant role in WT, but this was not evaluated in this study.
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