The Effect of Outpatient Web-Based Online Self Scheduling vs. Traditionally Staff Scheduling Systems on Progression to Surgery and No-Show Rates (Preprint)

Abstract

BACKGROUND Our orthopedic practice recently implemented a system that enables patients to schedule outpatient visits through an online portal without the need for traditional communication with office staff. Previous studies have found that the use of web-based scheduling correlates with reduced no show rates, staff labor, waiting time, and improved patient satisfaction. The appropriateness of the web-based scheduling and the rate of progression to surgery is unclear, as patients may not be appropriate candidates for surgical consultation. The purpose of this study was to compare the no show and surgical progression rates between online-scheduled and traditionally scheduled outpatient visits in our practice. OBJECTIVE Our primary hypothesis was that there is no significant difference in the rate of progression to surgery within three months after the initial ‘new visit’ between online-scheduling and traditionally scheduling services. The secondary hypothesis was that there was no significant difference in the no-show rate between the two scheduling services. METHODS All outpatient visits at a single large multispecialty orthopedic practice from 2/1/2022 through 2/28/2022 were collected. Scheduled visits were identified as either “online -scheduled” indicating patients scheduled their own visit through the new web-based patient portal system, or “traditionally scheduled,” indicating that the visit was scheduled with office staff. All visits were further categorized as either a “new visit” or a “follow-up visit.” Surgical records were reviewed to identify patients that underwent surgery within three months of their scheduled office visits. RESULTS Within the one-month timeframe, there were 71,673 traditionally scheduled visits and 3,058 patient scheduled visits. The rate of progression to surgery within three months after the new visit showed a significant difference (18% of online-scheduled vs. 21% of traditionally scheduled new visits; P=0.036). There was no difference in no-show rates between the two scheduling groups (4.5% of online-scheduled vs. 4.4% of traditionally scheduled visits; P=0.79). Subgroup analysis showed no significant difference in no-show rate when comparing new patients and follow-up visits separately. CONCLUSIONS Online-scheduling systems allow for greater patient autonomy and access to care, while reducing the administrative burden of office staff. A small but significant difference in the surgery rate with the traditional scheduling might be explained by the fact that the older generation still has more confidence in phone call scheduling than in using electronic applications. Moreover, the new office visits following urgent care referrals can be squeezed more rapidly into the schedule via the traditional scheduling because it is impossible to haggle with the system.