As the Department of Veterans’ Affairs scandal grows, scrutiny of wait times at civilian hospitals and clinics is bound to as well. Health systems might do well to begin reviewing their own access metrics.
Time spent waiting in emergency rooms and medical and surgical offices are enormous sources of frustration for patients, especially if they have to take time off work, according to research by Clifford Bleustein, MD, a Pricewaterhousecoopers analyst.
In a study of waiting times and patient ratings at a Midwest academic medical center’s ambulatory centers, Bleustein and his colleagues found a strong relationship between patient wait times and patient satisfaction — along with a number of other crucial factors.
Wait times “are not just a component of patient satisfaction, but an important component of quality care,” they write in the American Journal of Managed Care. Longer wait times were correlated with “significant declines” across patient ratings of staff friendliness, a physician’s explanations of illness and treatment, shared decision making, confidence in the care received and the likelihood of recommending a provider to others.
They found that patients who spent less than 20 minutes in a waiting room gave average satisfaction ratings of at least 4.5 on a 5 point scale, compared to an average score of 4.2 for those waited two hours. The average scores for those waiting in exams rooms, though, declined to 4.2 within 60 minutes.
When clinics do fall behind schedule, as inevitably will happen, “it is better to allow patients to wait outside in the waiting room rather than to quickly place them in an exam room,” Bleustein and colleagues suggest.
While time spent in ambulatory clinics are distinct from the weeks and months thousands of veterans apparently have waited to get urgent diagnostic services, in the age of healthcare reform and patient-centered care, patient satisfaction on all accounts is getting a renewed emphasis. In some cases it is being tied directly to reimbursement, or it can lead to lost reimbursement when patients go somewhere else.
As Bleustein and colleagues argue: “In a new healthcare economy, minimizing wait times must be taken seriously in order to compete, manage costs, and retain clientele.” With more and more retail clinics, including many owned by health systems in multi-health system regions like greater Philadelphia, the “quality of care, specifically, will become an ever-increasing factor in the competition for clients,” they write.
Same problems at civilian facilitites?
A comparison to the VA data on days spent waiting for diagnostics like endoscopies isn't available, although some have argued that waiting times at civilian providers may not be that much better than the VA in some areas.
"In my experience, few healthcare systems — private or public — are doing a good job with timely appointments. It's one reason ER use is so high," Art Kellermann, MD, dean of the Uniformed Services University medical school, wrote on Twitter.
In terms of access to see primary care docs and specialists, though, waiting times for an appointment vary quite a bit across the country, according to available data.
A survey in the 15 largest metropolitan areas found Americans waiting an average of 18 days to schedule an appointment for a doctor — and in some places more than a month.
Residents of Dallas were waiting an average of 8 days to see a family physician, compared to 66 days in Boston, where waits are the longest of the 15 cities surveyed. In New York, second to Boston in average waiting times, residents spent an average of 26 days waiting to see a family doc.
In Massachusetts as a whole, Bay Staters can wait an average of 39 days for appointment with a family doc, and half or more of primary care practices remain closed to new patients, the Massachusetts Medical Society found.