A modified walk-in system versus scheduled appointments in a secondary-care prosthetic and orthotic clinic

Abstract

Background:Waiting is common in health care, delays intervention, and has negative effects on satisfaction with services.Objectives:To evaluate effects of a modified walk-in system, where patients were invited consecutively from the waiting list to attend the clinic on a walk-in basis, on waiting times, services, and work environment.Study design:Parallel-group trial.Methods:In all, 1286 consecutive patients in need of shoe insoles were randomized to waiting lists for modified walk-in (n = 655) or a scheduled appointment (n = 631). Seven staff members also participated.Results:The median indirect waiting time to first appointment was 40 days shorter for modified walk-in (135 days) than for scheduled appointment (175 days; p < 0.001); 17% of those randomized to modified walk-in did not attend the clinic compared to 6% for scheduled appointment (p < 0.001). Mean direct waiting time in the waiting room was 9.9 min longer for modified walk-in than for scheduled appointment (p < 0.001). Patients attending modified walk-in or a scheduled appointment reported similar levels of satisfaction with services. Staff reported more support from co-workers with modified walk-in than with scheduled appointment (p = 0.041).Conclusion:The modified walk-in can reduce indirect waiting times without any substantial worsening of direct waiting times, service quality, or work environment. Studies are needed to investigate why many patients drop out from modified walk-in.Clinical relevanceA modified walk-in system can cut the queues and create more timely interventions by reducing indirect waiting times. This system can therefore be recommended in secondary-care prosthetic and orthotic clinics to reduce patients’ suffering from their health condition.

A model of access combining triage with initial management reduced waiting time for community outpatient services: a stepped wedge cluster randomised controlled trial

“…However, previous literature has shown that single injections of resources, without changes to service delivery, are unlikely to make a sustainable difference to waiting times [ 35 , 36 ]. STAT is also consistent with other waiting time initiatives that have advocated approaches combining one-off backlog reduction strategies followed by the implementation of patient flow interventions [ 21 , 24 ]. In the current trial, a comparison of mean waiting times for a small sample of consecutive patients entering the service immediately before and after the waitlist reduction strategies provides some indication of their impact.…”

“…Reductions in waiting time achieved with STAT also appear to be comparable with other patient flow initiatives reported in community outpatient settings, although direct comparison is difficult due to heterogeneity in the ways in which wait times are measured. For example, there was a 23% reduction in median waiting time for a prosthetics clinic through changing scheduling to a modified walk-in system, rather than scheduled appointments [ 24 ]; Lynch et al achieved a 70% reduction in the number of people on a waiting list for mental health services with an intervention that addressed the residual waitlist in combination with new approaches to treatment and triage [ 23 ]; and Maddison et al described a reduction in waiting time for musculoskeletal services despite an increase in referrals through creation of a back pain pathway [ 34 ]. In contrast to these studies that all described interventions developed specifically for the services in which they were conducted, the current trial provides evidence of a structured approach that can be used to reduce waiting time across a broad range of settings.…”

A modified walk-in clinic for shoe insoles

“…4–6 To address these potential disadvantages, we chose to test a modified walk-in (MWI) system, where patients in need of shoe insoles were invited consecutively from a waiting list to attend our prosthetic and orthotic clinic on a walk-in basis. 7 We found that an MWI system reduced median time from referral to the first appointment by 40 days (23%) compared to SA, without substantially worsening waiting times in the waiting room, service quality or work environment. However, 17% of those randomized to the MWI system did not attend the clinic, compared to 6% for SA.…”

“…9,10 Consequently, they do not readily explain why the non-attendance rate was higher with the MWI system than the SA system in our original study. 7 Two interpretations are possible. First, the reasons for not attending the MWI clinic and SA could be similar but expressed differently; for example, both MWI clinic visit and SA can be forgotten or postponed if in conflict with other commitments, but it is presumably easier to forget or postpone an MWI visit than an SA, as the person is not committed to attending on a specific day and time.…”

“…Hopefully, by using the MWI system, waiting times will reduce in the long run. 7 Ten percent of the patients stated that they did not attend the clinic because they did not need insoles anymore as their problems had resolved. This figure is similar to or higher than that in other studies 9,10 and may reflect the fact that our patients typically had activity-related pain in the lower extremities, which may improve over time.…”