A web-based appointment system to reduce waiting for outpatients: A retrospective study

Reducing outpatient waiting times has been the focus of a large number of studies [1‐3] because waiting and treatment times are usually regarded as indicators of service quality [4]. The Patient's Charter of the UK Government sets a series of standards which state that all patients must be seen within thirty minutes of their appointment time [1]. Outpatient waiting time can be divided into two types: waiting before consultation, and waiting after consultation [5]. Time spent waiting before consultation has attracted much research attention, and can be further separated into waiting time for registration, and waiting time for consultation [6]. Because of China's limited medical resources, long waiting times for registration are common in the health care system, and the registration waiting time is generally much longer than the consultation waiting time. Long registration waiting times for outpatients have already become a long-festering healthcare problem in China [7]. For this reason, our study focuses on registration waiting time only.

In recent years, China has been in the process of implementing health care system reform [8]. The aim of the reform was to provide basic and convenient medical care. Easy access to a doctor is the first step for patients using health services. The traditional registration method (usual queuing method), had unacceptable waiting times, and placed great stress on clinic staff [7]. With the rapid development of the internet over the previous 2-3 years, some hospitals trialed the use of web-based appointment systems (WAS) for outpatients [9]. In 2009, supported by the Ministry of Health, all public tertiary hospitals began to use WAS. However, to date there are few studies about the efficacy of WAS in China. Thus, our study aims to evaluate the efficacy of WAS for outpatients, by comparing waiting times for the WAS and usual queue method, and investigating reasons for not using the WAS.

A total of 5641 people made an appointment using the WAS in the study period, from which 500 were randomly selected for a telephone interview. Responses were obtained from 369 (73.8%) participants. For the usual queuing method group, 463 participants completed a questionnaire while queuing for registration, corresponding to a response rate of 92.6% (463/500).

One of the greatest complaints of the Chinese public is the amount of time it takes to queue for outpatient registration in China. From our investigation we noted that some participants even waited in line all night (13.5 hours) to ensure a registration with a certain physician. To effectively reduce registration waiting times in the usual queuing method is an urgent issue that needs to be resolved. This study demonstrates that that using a WAS could substantially increase patients' satisfaction with outpatient registration. Although some time is still needed to make appointments using the WAS, it can significantly reduce total waiting time, especially invalid waiting time.

Despite the benefits using of the WAS, many people still registered via the usual queuing method. One reason we identified for not using the WAS was that over half of the participants did not know that an appointment can be obtained through the internet. This indicates that more effort should be made by hospitals and health service providers to promote and encourage the use of the WAS. By using a WAS, hospitals and other health service providers can reduce their invalid waiting time and anxiety in queues. Another important finding was that registration demand varied according to day of the week and time of the day. After investigating patient's appointment time in the WAS, we found that 43.8% of patients (2471) wanted to see a doctor on Monday or Tuesday, and 71.0% of them preferred it to be in the morning. This makes it very difficult to obtain registration during these periods. By making patients aware of this, it would be possible to encourage them to register on days with a lower outpatient load. This will help distribute the registration demand evenly and improve the allocation of medical resources.

Non-attendance is one of the potential problems for hospitals using a WAS. In our study, the overall non-attendance rate was 14.4%. This is consistent with the non-attendance rates reported in related studies, which range from 12% to 27% [10, 11]. We found that the proportion of non-attendance was higher on Mondays than on other days, which differs from another study, which reported that non-attendance rates were higher on Sundays than on other days [12]. The failure of patients to meet scheduled appointments disrupts the orderliness of medical care and wastes limited medical resources [12, 13]. Some measures had already been adopted to address this issue, such as preventing patients who failed to attend appointments three times in the preceding 12 months from making any new appointments on the web.

Many studies have focused on reasons for non-attendance, and some reliable suggestions for improvement have been provided (e.g., using a reminder system) [14‐16]. To improve the management of outpatients, we assessed non-attendance related factors in our study. We found that hospital department, day of the week, and time of the day were significantly associated with non-attendance. The proportion of non-attendance was higher following registration with medical specialists (e.g. specialists in Neurosurgery) and most non-attendance occurred in the afternoon.

Our study has some potential limitations. First, we failed to collect data on the reasons for non-attendance from the participants using the WAS, because the majority of people who failed to attend their appointments declined to give an explanation. Second, because our study participants were from a large tertiary hospital, and different hospitals may have a different WAS, our findings may not reflect WAS use in other hospitals. Some relatively small hospitals may not need to use a WAS, because they do not experience high demand for registration. Despite these potential limitations, our study demonstrated that the WAS is an efficient and satisfactory means of obtaining registration, and identified factors that contribute to not using the booking system. By identifying these factors, we intend to develop intervention strategies to further improve the usability of the WAS and provide convenience for patients.

Our study showed that use of a WAS can effectively increase patient satisfaction with getting a registration and reduce waiting times. A lack of information about online appointments was the main reason for not using the system. Non-attendance is an inevitable problem in the development of a web-based registration system. To increase the efficiency of the registration system, and to reduce non-attendance rates, further studies on various interventions such as the promotion of online registration, and use of a reminder system should be considered.

The authors declare that they have no competing interests.