An audit of the appointment booking system and patient waiting time in an ultrasound unit in Nigeria: A need to eliminate congestion in our public hospitals

Abstract

Background: Congestion of patient waiting areas at commencement of work is the usual scenario in Nigeria's public hospitals. This strains the personnel and facilities. Patients are dissatisfied and lose faith in the system. This study aims to audit the booking system, patient waiting time, and causes of congestion in an ultrasound unit. Materials and Methods: This is a prospective, descriptive study involving 350 patients referred from general outpatient and specialist clinics to the ultrasound unit, twice weekly for 6 weeks. Patients were grouped into two: those with scheduled appointments and the unbooked. The time of scheduled appointment and arrival in the unit and the time of commencement and conclusion of the examination were recorded. Results: Three hundred and eighteen patients had scheduled appointments, while 32 were unbooked. Half of the later were emergencies and the other half were walk-ins. There was no consistency in number of slots and block size. Large blocks of over 20 patients were observed on 33.3% of the days and 51.26% of the patients were given 8:00 am appointments. The average patient waiting time is 132.11 minutes but range from 62 to 220 minutes daily. The radiologists resumed work between 8:17 and 9:29 am each scan day. The average waiting time is shorter for patients who arrived after 11:00 am. Conclusion: Ineffective booking of appointments and Sonologist's tardiness are major predisposition to congestion. Appointments in small blocks at 30 minutes intervals will eliminate congestion, reduce patient waiting time, and improve satisfaction. Point-of-care ultrasound should be introduced in outpatient clinics.

Assessment of Scheduling Method,Appointment Delay, and No-show Rate in the Ultrasound Unit of a Nigerian Teaching Hospital

“…The causes of long waiting time in the present study were associated with ineffectual appointment scheduling, mismatch between patient arrival time, and staff service commencement time/staff inefficiencies, inconsistent power supply, and equipment function-related disruptions. Akintunde et al (2019) identified ineffective scheduling and unpunctuality of sonologists as major causes of congestion in ultrasound units, findings that showed similarity to the present work. To obviate this problem, the researchers made the following recommendations: Changing the appointment system from single block to modified block scheduling, or individual scheduling; ensuring commencement of service to correspond to arrival time of patients; and prioritizing seeing patients and postponing other activities to less busy hours; provision of a dedicated power generating set which will solve the problem of power outage in the unit; ensuring that all the ultrasound machines are functional per time through good quality control practices which will reduce to the barest minimum the contribution of equipment breakdown to patient delays.…”

“…To obviate this problem, the researchers made the following recommendations: Changing the appointment system from single block to modified block scheduling, or individual scheduling; ensuring commencement of service to correspond to arrival time of patients; and prioritizing seeing patients and postponing other activities to less busy hours; provision of a dedicated power generating set which will solve the problem of power outage in the unit; ensuring that all the ultrasound machines are functional per time through good quality control practices which will reduce to the barest minimum the contribution of equipment breakdown to patient delays. Akintunde et al (2019) suggested modified block scheduling and introduction of point-of-care ultrasound to minimize service bottlenecks and improve patient satisfaction.…”

“…French et al (2014) reported 3.8 ± 2.5 hours as the average waiting time for an ultrasound. Akintunde et al (2019) recorded an average patient waiting time of 132.11 minutes with a daily range from 62 to 220 minutes and shorter average waiting time for patients who arrived after 11:00 am . The causes of long waiting time in the present study were associated with ineffectual appointment scheduling, mismatch between patient arrival time, and staff service commencement time/staff inefficiencies, inconsistent power supply, and equipment function-related disruptions.…”

Causes of Obstruction in the Outpatient Department of National Hospital, Sri Lanka: A Qualitative Study

“…Another study revealed that the major cause for congestion is the type of appointment scheduling adopted in the unit. The schedule is inconsistent in terms of start time, number of patients per block, and time slots (Akintomide et al, 2019). The congestion varies depending on health facilities and many other factors, such as quality of medical facilities, quantity and quality of medical equipment, the capacity of human resources, and speed of a registration process (Babalola et al, 2013).…”

E-appointments at primary care physicians during Covid-19 pandemic: viewpoint and satisfaction of medical consumers

“…By using the traditional walk-in method where the patient is required to wait in line, the waiting time for patients increases, it overloads the MHF and it is influencing the work on the physician [1]. Additionally, crowded waiting rooms for the patients are a usual thing in the MHF [2]. With the fast improvement of the Internet information technology over the years, many MHF lean towards using electronic appointment systems for patients (EASP) [1].…”