Patient punctuality and clinic performance: observations from an academic-based private practice pain centre: a prospective quality improvement study.
OBJECTIVE
The aim of this study was to examine the effects of an intervention to alter patient unpunctuality. The major hypothesis was that the intervention will change the distribution of patient unpunctuality by decreasing patient tardiness and increasing patient earliness.


METHODS
Prospective Quality Improvement.


METHODS
Specialty Pain Clinic in suburban Baltimore, Maryland, USA.


METHODS
The patient population ranged in age from 18 to 93 years. All patients presenting to the clinic during the study period were included in the study. The average monthly volume was 86.2 (SD=13) patients. A total of 1500 patient visits were included in this study.


METHODS
We tracked appointment times and patient arrival times at an ambulatory pain clinic. An intervention was made in which patients were informed that tardy patients would not be seen and would be rescheduled. This policy was enforced over a 12-month period.


METHODS
The distribution of patient unpunctuality was developed preintervention and at 12 months after implementation. Distribution parameters were used as inputs to a discrete event simulation to determine effects of the change in patient unpunctuality on clinic delay.


RESULTS
Data regarding patient unpunctuality were gathered by direct observation before and after implementation of the intervention. The mean unpunctuality changed from -20.5 min (110 observations, SD=1.7) preintervention to -23.2 (169, 1.2) at 1 month after the intervention, -23.8 min (69, 1.8) at 6 months and -25.0 min (71, 1.2) after 1 year. The unpunctuality 12 months after initiation of the intervention was significantly different from that prior to the intervention (p<0.05).


CONCLUSIONS
Physicians and staff are able to alter patient arrival patterns to reduce patient unpunctuality. Reducing tardiness improves some measures of clinic performance, but may not always improve waiting times. Accommodating early arriving patients does serve to improve clinic performance.
Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
Kayode A
KA
Williams
Johns Hopkins Carey Business School and Armstrong Institute for Patient Safety and Quality, Baltimore, Maryland, USA.
Chester G
CG
Chambers
Johns Hopkins Carey Business School and Armstrong Institute for Patient Safety and Quality, Baltimore, Maryland, USA.
Maqbool
M
Dada
Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
Julia C
JC
McLeod
Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
John A
JA
Ulatowski
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001071:Appointments and Schedules; D006801:Humans; D008875:Middle Aged; D018710:Pain Clinics; D010349:Patient Compliance / Q000706:statistics & numerical data*; D011331:Private Practice; D011446:Prospective Studies; D058996:Quality Improvement; D013997:Time Factors; D055815:Young Adult
Health Services Administration & Management