Keywords
Patient waiting time, outpatient clinic, Viet Duc Hospital, health insurance
Patient waiting time, outpatient clinic, Viet Duc Hospital, health insurance
This version contains some major changes in the introduction section, that we have added the definition of patient waiting time and the patient waiting time across countries. In the method section, we have clarified how we used secondary data instead of collecting primary data. We have also mentioned how we collected these data in the software. In the result section, we have added standard deviation for each measure in tables. Finally, we have rewritten the discussion and conclusion to fit the research question and results. We have also modified the conclusion in Abstract to be appropriate with the conclusion of the revised manuscript.
See the authors' detailed response to the review by Duong Minh Duc
See the authors' detailed response to the review by Ozayr H. Mahomed
Patient waiting time is defined as the time patients have to wait before meeting clinical staffs or using health service needed1–3. Although patient waiting time has been defined as an important indicator in the assessment of healthcare quality1 and patients’ satisfaction towards healthcare services2,3, lengthy outpatient waiting time has posed a great challenge to maximize healthcare quality4. The patient waiting time varies across settings. In Ireland, a study conducted in an outpatient clinic showed that 50% of patients waited 60% for their appointment4. In Nigeria, 60% patients had to wait 90–180 minutes for receiving examination5. Even in the USA, the average patient waiting time was from 60 minutes in Atlanta to 188 minutes in Michigan6. This issue is worse among countries with low provider-patient ratios7.
Vietnam is among highly populated countries that are fueled by patient overload, especially in the central hospitals8. Thus, extended waiting time has remained highly prevalent. In 2015, a study in Ha Dong General Hospital by Nguyen indicated the average time of medical examination was 96.91 ± 72.16 minutes. The average waiting time was 63.05 ± 62.96 minutes9. In 2012, a study by Le et al. conducted in an outpatient clinic suggested that the average time spent from registration to doctors’ conclusions was 246.87 ± 104.55 minutes (4.11 ± 1.7 hours)10. Accordingly, patient waiting time is influenced by various factors, such as working procedure, patient overload and appointment schedule11,12. Previous study suggests that appropriate operation of medical examinations could shorten patient waiting times13.
Viet Duc is a central hospital, with the aim of ensuring health for Northern Vietnamese patients. The outpatient clinic welcomes hundreds of patients on a daily basis and is often overloaded. Thus, Viet Duc Hospital is always seeking evidence-based solutions to enhance the quality of healthcare services. However, data on patient waiting time in the outpatient clinic at Viet Duc Hospital remains limited. Thus, the aim of this study was to examine patient waiting times in the outpatient clinic, Viet Duc Hospital, thereby enabling the hospital administration to design evidence-based interventions to improve the satisfaction of patients.
A cross-sectional study was conducted from June 2014 to June 2015 in the outpatient clinic of Viet Duc Hospital (Hanoi, Vietnam). It is the largest surgical center of Vietnam, with approximately 1300 beds and approximately 150,000 patients using outpatient services annually.
All patients that underwent a medical examination during this time were eligible for the research. There were no specific exclusion criteria used in this study. Data from a total of 137881 patients were extracted for final analysis.
Time data was collected via Hospital Management Software, which was developed to support hospital management in Viet Duc Hospital. Data concerning the waiting time for utilizing service was computed as the time that patients met the physicians minus the time that the patient registered. These data were automatically recorded when the patients registered and when they met the physicians. We used secondary data instead of primary data in order to get the accurate data for the analysis. By using time record function from the software, we could identify exactly when the patients used their services needed. Due to using secondary data, we did not collect and report the demographic characteristics of patients.
In this study, variables of interest included health insurance status, the waiting time for health service use, year (2014 and 2015), months of the year, weekdays and hours of the day.
Data was extracted in Microsoft Excel form and Stata 12.0 was employed to analyze data: the average time (M±SD), frequencies and percentage (%). Mann-whitney test was used to test the differences of waiting time among variables. P-value < 0.05 was considered statistical significance. Since we extracted data from the software, there was no bias in this study.
Table 1 illustrates the average waiting time of patients in the outpatient clinic of Viet Duc Hospital. There was a total of 137881 patients who had a medical examination during the time of conducting the research, in which 38298 patients had health insurance, accounting for approximately 27.8%. The average waiting time from registration to preliminary diagnosis in 2014 was 50.41 minutes and in 2015 was 42.05 minutes.
Patient waiting time regarding the hours of the day are presented in Table 2. The largest number of patients having a medical examination were in the hours 7:00–8:00 and 8:00–9:00. The lowest number of patients having medical examination were in the hours 11:00–12:00, 15:00–16:00 and 16:00–16:30 (because the hospital was closed at 16:30). The longest patient waiting time was at 6:30 to 7:00, and the time among those having health insurance was 81.54 minutes, while the longest patient waiting time among those who did not have health insurance was 70.63 minutes.
Table 3 shows patient waiting time regarding weekdays. The largest number of patients having a medical examination was on Monday, Tuesday and Wednesday. There were fewer patients on Thursday and Friday. The shortest waiting time was on Thursday, while the longest waiting time was on Tuesday.
Table 4 demonstrates patient waiting time regarding the month of the year. Generally, few patients had medical examinations in February, 2015. The longest waiting time was in July, August, and September for both insured and uninsured patients.
The purpose of this study was to assess the patient waiting time in an outpatient clinic, Viet Duc Hospital, Hanoi, Vietnam. Our findings indicate that the average waiting time from registration to preliminary diagnosis was decreased in a period of two years from 2014 to 2015. Findings also suggest the difference regarding waiting time between the morning and the afternoon, those having health insurance compared to those that did not have health insurance.
The average waiting time was lower than previous studies at Ha Dong General Hospital (Hanoi City)9, Trung Vuong Emergency Hospital (Ho Chi Minh city)10, and Nguyen Trai Hospital (Ho Chi Minh City)14. However, our findings were higher than studies by Vu at the National Hospital of Tropical Diseases (Hanoi City)13, and Cole in Australia15. It could be hypothesized that the outpatient clinic at Viet Duc Hospital is well-qualified (with skilled physicians and advanced medical technologies), patients directly come to the Hospital without visiting healthcare facilities at grass-roots levels, leading to overload. In fact, each department at the hospital receives approximately 130,000 medical visits every year; therefore, overload frequently happens. The study in Trung Vuong Emergency Hospital was conducted in 2011 when the decision 1313/QĐ-BYT related to the medical examination procedure was not implemented. Therefore, patient waiting time might be prolonged.
The higher number of visited patients in the morning and the afternoon observed in our study could be potentially explained since patients prefer to have health consultations in the morning, as they could receive the results of clinical tests within the day. A study by Han et al. also indicated that the number of patients that visit An Giang Cardiovascular Hospital (An Giang Province) in the morning is higher than the afternoon16. Thus, our study highlights the essential need for well-distribution of human resources to shorten patients’ time of medical consultations.
Noticeably, those having health insurance had to wait for their turn longer than those that did not have health insurance. This may potentially reflect shortcomings regarding complicated administrative procedures that could extend waiting time9. In fact, cumbersome administrative procedures related to health insurance remain the pressing issue in Vietnamese healthcare system17. Since this strategy may be hampered by health insurance-related procedures, stakeholders should pay attention on simplifying administrative procedures for insured patients.
Our results provided evidence that despite the decrease of waiting time from 2014 to 2015, waiting time was much higher among patients having health insurance compared to their counterparts. The findings suggest that human resources promotion and distribution should be emphasized in outpatient clinics and health insurance-related administrative procedures should be simplified.
Dataset 1: Raw data used in the construction of Table 1– Table 4. Data from June 2014-June 2015 detailing waiting times of patients and if health insurance was present. doi, 10.5256/f1000research.11045.d15711218
TDT, UVN, BXT conceived, designed and conducted the experiments; TDT, UVN, VMN collected the data; TDT, UVN, BXT, VMN analyzed and interpreted the data; TDT, UVN, BXT, VMN wrote the paper. All authors read and revised the manuscript.
We would like to express our deepest gratitude for the great contributions of the authorship and the support of the Director of Viet Duc Hospital to conduct this study.
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Competing Interests: No competing interests were disclosed.
Reviewer Expertise: Health system strengthening, quality improvement
Is the work clearly and accurately presented and does it cite the current literature?
No
Is the study design appropriate and is the work technically sound?
No
Are sufficient details of methods and analysis provided to allow replication by others?
No
If applicable, is the statistical analysis and its interpretation appropriate?
Partly
Are all the source data underlying the results available to ensure full reproducibility?
Yes
Are the conclusions drawn adequately supported by the results?
No
Competing Interests: No competing interests were disclosed.
Reviewer Expertise: Health system strengthening, quality improvement
Competing Interests: No competing interests were disclosed.
Is the work clearly and accurately presented and does it cite the current literature?
Yes
Is the study design appropriate and is the work technically sound?
Yes
Are sufficient details of methods and analysis provided to allow replication by others?
Yes
If applicable, is the statistical analysis and its interpretation appropriate?
Partly
Are all the source data underlying the results available to ensure full reproducibility?
Yes
Are the conclusions drawn adequately supported by the results?
No
Competing Interests: No competing interests were disclosed.
Alongside their report, reviewers assign a status to the article:
Invited Reviewers | ||
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