Punctual patients perfect performance? Perhaps

The Pediatric Insider

© 2014 Roy Benaroch, MD

Here’s a clever study, just published in BMJ Open. Physicians affiliated with Johns Hopkins School of Medicine looked at the consequences of a new, hard-nosed policy for patients arriving late to a pain management clinic.

Under the new rules, any patient arriving late was told that they had to reschedule. The authors then tracked the level of “unpunctuality” (their word) of the patients over twelve months, along with other measures of how the clinic and patients were staying on time.

At the beginning of the study, at baseline, 90% of patients in this clinic arrived on time; after implementation, the clinic was able to improve that to 95%. The average time patients came to their appointment changed from 20 minutes early to 25 minutes early. I’m not thinking that either of those changes is huge, but this clinic started with a population that was used to coming in early for appointments. Maybe the effect would be larger in a more-typical setting.

Also, the authors found that under the new policy they were able to see all patients within their four hour allotted clinic time about 50% of the time, versus about 40% before the study. I suppose closing the clinic on time more often would be helpful for doctors and staff.

But was it helpful for patients? Not so much. The average wait time over the study period actually increased by one minute, mostly because patients started coming in even earlier for their appointments.

So: the new policy or refusing to see late patients did change behavior, by getting patients to show up 5 minutes earlier for their appointments. It helped the clinic run a little more efficiently, at least as measured by closing on time more often, though that effect was modest. The patients just ended up waiting a little longer.

There’s got to be a better way.

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