Kagedan Daniel J, Takabe Kazuaki
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.
Gland Surg. 2021 Feb;10(2):551-558. doi: 10.21037/gs-20-623.
Prolonged outpatient clinic appointments can disrupt schedules, impacting patients and providers. We sought to define features of the longest ambulatory appointments in a breast surgery clinic, and to ascertain whether patients attending these appointments consistently have protracted appointments.
A single-institution retrospective cohort study was conducted of breast surgery clinic patients, January 2017 to May 2019, and the longest 1% of appointments identified using a real-time patient tracking system. A primary chart review was performed, and data abstracted. Other appointments attended by these patients were identified, and the ratio of appointments >75th percentile duration (protracted appointments) to the total appointments during the study period was calculated, enabling comparison for patients with consistently protracted (ratio >50%) sporadically protracted appointments (≤50%). Descriptive analysis was performed, and results reported as medians with inter-quartile ranges.
A total of 15,265 clinic appointments were identified, and the longest 148 (exceeding 244 minutes) analyzed. Median appointment length was 264 minutes (inter-quartile range: 253-290). 70% were new patient appointments, and 54% of patients underwent a test/investigation that day. A minority were obese (39%), smokers (41%), diagnosed with a psychiatric comorbidity (34%), had a genetic cancer syndrome (22%), or received unexpected news at their appointment (16%). Of 118 patients with multiple appointments, 26% had consistently protracted appointments and 74% sporadically protracted appointments.
The lengthiest appointments are usually newly diagnosed cancer patients. Only a minority of patients have consistently protracted appointments, implying that a patient's previously prolonged appointment may not predict future long appointments.
门诊预约时间过长会打乱日程安排，对患者和医护人员都会产生影响。我们试图明确乳腺外科门诊中最长门诊预约的特征，并确定就诊这些预约的患者是否始终有较长的预约时间。
对2017年1月至2019年5月乳腺外科门诊患者进行单机构回顾性队列研究，使用实时患者跟踪系统确定最长的1%的预约。进行了一次主要病历审查并提取了数据。确定这些患者参加的其他预约，并计算预约时间超过第75百分位数时长（延长预约）与研究期间总预约数的比例，以便对预约时间始终延长（比例>50%）与偶尔延长（≤50%）的患者进行比较。进行了描述性分析，结果以中位数和四分位间距报告。
共确定了15265次门诊预约，分析了最长的148次（超过244分钟）。预约时间中位数为264分钟（四分位间距：253 - 290）。70%是新患者预约，54%的患者在当天接受了检查/调查。少数患者肥胖（39%）、吸烟（41%）、被诊断患有精神疾病合并症（34%）、患有遗传性癌症综合征（22%）或在预约时收到意外消息（16%）。在118名有多次预约的患者中，26%的患者预约时间始终延长，74%的患者偶尔延长。
最长的预约通常是新诊断的癌症患者。只有少数患者预约时间始终延长，这意味着患者之前的预约时间延长可能无法预测未来的长时间预约。
