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时钟背后：阐明导致门诊预约时间延长和患者等待时间延长的因素。

Behind the clock: elucidating factors contributing to longer clinic appointment duration and patient wait time.

机构信息

Department of Surgical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA.

Jacobs School of Medicine and Biomedical Sciences, University of Buffalo, Buffalo, NY, USA.

出版信息

BMC Health Serv Res. 2021 Jan 26;21(1):87. doi: 10.1186/s12913-021-06079-y.

DOI:10.1186/s12913-021-06079-y
PMID:33499845
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7836477/
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.

摘要

背景

门诊等候时间延长会打乱患者的日程安排并降低其满意度。本研究旨在调查与患者等候时间（WT，从登记到进入诊室）、医生近似工作时间（ACT，从完成护士评估到离开诊室）和总就诊时间（TAL，从登记到离开诊室）相关的因素。

方法

对 2017 年至 2019 年间在一家医疗机构进行的乳腺外科门诊患者进行了一项单机构回顾性研究，使用实际就诊时间。通过前后对比，比较了五天 8 小时/天（从四天 10 小时/天）的高级执业护师（APP）工作周。使用非参数检验，报告中位数和四分位距（IQR）。

结果

共确定了 15265 次就诊。总体 WT 为 15.0 分钟（IQR：6.0-32.0），ACT 为 49.0 分钟（IQR：31.0-79.0），TAL 为 84.0 分钟（IQR：57.0-124.0）。培训生与 ACT 延长 30.0 分钟相关（p<0.0001）；这种增加的时间在随访预约中最大，在新患者中最小。与按时就诊的患者相比，就诊时间晚（超过 5 分钟）的患者的 WT（11.0 分钟比 15.0 分钟，p<0.0001）和 ACT（43.0 分钟比 53.0 分钟，p<0.0001）均更短。就诊人数较多的日子（就诊人数与 APP 比值较高）显示出就诊时间增加。在过渡到五天 APP 工作周后，ACT 减少。

结论

高流量门诊和培训生的参与会延长门诊就诊时间。增加 APP 协助、改变工作时间表并将随访预约分配给非培训生可能会减少就诊时间。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6065/7836477/40affffb4ecd/12913_2021_6079_Fig6_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6065/7836477/b1fbaf167332/12913_2021_6079_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6065/7836477/b3a92cd25e30/12913_2021_6079_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6065/7836477/117cc36b5e61/12913_2021_6079_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6065/7836477/a242e98cd9da/12913_2021_6079_Fig4_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6065/7836477/38dba410e54d/12913_2021_6079_Fig5_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6065/7836477/40affffb4ecd/12913_2021_6079_Fig6_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6065/7836477/b1fbaf167332/12913_2021_6079_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6065/7836477/b3a92cd25e30/12913_2021_6079_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6065/7836477/117cc36b5e61/12913_2021_6079_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6065/7836477/a242e98cd9da/12913_2021_6079_Fig4_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6065/7836477/38dba410e54d/12913_2021_6079_Fig5_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6065/7836477/40affffb4ecd/12913_2021_6079_Fig6_HTML.jpg

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本文引用的文献

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