Improving Waiting Time in an Oncology Outpatient Clinic at a Tertiary Hospital

Abstract

Background: Long waiting times are a common problem in public referral centers. Thus, this study examines the effectiveness of a decision-making scheduling system that was implemented to reduce the waiting time in an oncology outpatient department (OPD) at a tertiary hospital in southern Thailand.  Methods: We propose a new scheduling approach based on the Lean management system to reduce OPD waiting time without increasing healthcare resource use. In addition to the scheduled appointment slot, we applied a new scheduling system based on the following three key points: (1) review the necessity of laboratory tests for each patient before the visit date, (2) inform the patient regarding blood draws at arrival and obtain blood results before the doctor’s consultation, and (3) reschedule new patients with their planned treatment start date. Using an in-house electronic hospital information system, we retrospectively reviewed patients who visited oncology OPD between January 2015 and December 2017, then compared the waiting time and number of patient visits before and after implementing the new scheduling system. The waiting time were determined and analyzed by Wilcoxon rank-sum test. Results: The total OPD waiting time of new patients significantly decreased from 361 minutes (interquartile range [IQR] 218.2–454) to 293 minutes (IQR 217–375; p < 0.001). The rate of new patients who received anticancer treatment within two visits was increased from 75.4% to 97% (p < 0.001). Correspondingly, the total OPD waiting time of follow-up patients was also significantly reduced from 213 minutes (IQR 113–332) to 122 minutes (IQR 53–217; p < 0.001). In addition, the new scheduling system reduced the average OPD time by 11.4% (p < 0.001). Conclusion: A decision-making scheduling system based on the use of existing capacity can effectively reduce waiting time in an oncology outpatient clinic.