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Original Article
A Study of Determinant of Long Waiting Period in Outpatient Department
and Recommendation on reducing waiting time in a Superspecialty Hospital
Authors
N Junior Sundresh , Dr Rajesh V Nagmothe2
1
1
Deputy Medical Superintendent and Associate Professor, Department of Surgery, Rajah Muthiah Medical
College, Annamalai University, Chidambaram, Tamil Nadu, India,
2
Student, Department of Management Studies, Annamalai University, Chidambaram, Tamil Nadu, India and
Associate professor, Dept. of Anaesthesia, GMC & SSH, Nagpur, Maharashtra
Corresponding Author
Dr Rajesh V Nagmothe
44, Panchdeep Nagar, Wardha Road, Near Redison Blu Hotel, Nagpur, Maharashtra
Email: rajeshnagmothe@[Link], Phone No 9323602314

Abstract
A study of determinant of long waiting period in outpatient department and recommendation on reducing waiting time
in Superspeciality hospital
This is a cross sectional observational study conducted in a tertiary care Superspeciality hospital, during the study both
qualitative data like factors responsible for long waiting time in OPD, its impact on patient satisfaction and quantitative
data like average waiting time of the patients in outpatient department was studied.
Aim and Objectives
1) To find the determinant of long waiting period in OPD
2) To determine the patients satisfaction for OPD services
3) To give recommendation on reducing waiting time in the out-patient department
Material and Methods: The systematic sampling technique was carried out by simple random sampling. The first
patient visiting the registration counter was taken as starting point and thereafter next patient randomly selected who
came for registration to the OPD after the interval of 2 to 3 minutes, was enrolled in the study if he give consent till
100 patients was selected in each day. This data was collect for 5 day (Monday to Friday). The questioner was collected
when the patient’s complete consultation was done.
Results: Form the observation of this study and revive of liturature we can definitely conclude that due to heavy patients
inflow in our outpatient department we need to analyse and adopt verious que management methods. Whether it's a time
used for registration of patient, routine doctor's appointment, emergency room treatment, laboratory/diagnostic test,
procedures, receiving the results of various tests, waiting happens to just about everyone seeking medical care. It's often one
of the most frustrating parts about healthcare delivery system. Waiting times for elective care have been considered a
serious problem in many health care systems since it acts as a barriers to efficient patient flows and it should be minimum to
improve patient satisfaction.
Conclusions: From the finding of above studt it was clearly indicate that maximum patients (81.55%) feel need for
improvement in outpatient service and the waiting time in outpatient department was most distressing (73.33%) and its
reduction was to be done on priority to improve.
Keywords: Outpatient department, patients waiting, superspeciality hospital, Que managment.

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Introduction patients spend 2-4 h in the outpatient departments
In any hospital the outpatient department being before seeing the doctor.[6,7,8] In the developing
the first point of contact between the patient and countries where the health facility are unevenly
the hospital, is the mirror of the hospital, which distributed, number of patients visiting
reflects overall functioning of the hospital. With multispecialty hospital was increasing. A source
increasing number of patients visiting of dissatisfaction with health care reported by
multispecialty hospital, OPD services of majority patients is having to wait a long period of time in
of the hospitals are facing queuing and waiting the clinic,[9] and several studies have documented
time problems that was important reason for the negative association between increased
patient dissatisfaction. Waiting for consultation waiting time and patient satisfaction with primary
and getting investigations done in the hospital is care.[10,11]
one of the main reason behind patient does not The duration of waiting time varies from country
want to avail the services of that particular to country, and even within country it varies from
hospital. Provision of quick and efficient services center to center. Long waiting times have been
is the need of time. reported in both developed and developing
Most Patients spend substantial amount of time in countries. In the USA, an average waiting time of
the clinics waiting for services to be delivered by about 60 min was found in Atlanta,[12] and an
physicians and other allied health professionals. average of 188 min in Michigan.[13]
The actual time spent for consultation was 5 to 10 In Nigeria, an average waiting time of about 173
minutes as compare to large waiting time. The min was found in Benin,[9] while in University
degree to which health consumers are satisfied College Hospital Ibadan, a mean waiting time of 1
with the care received is strongly related to the h 13 min was observed.[14]
quality of the waiting experience. Healthcare
organizations that strive to deliver exceptional Background of Study
services must effectively manage their clinic wait. The study was conducted in the Superspeciality
[1]
hospital, a tertiary care centre in central India. The
Waiting time refers to the time a patient waits in patients coming in this Hospital consist from the
the outpatient department before being seen by patient referred from the Government Medical
one of the clinic medical staff.[2] Patient clinic College and Hospital and the patient coming from
waiting time is an important indicator of quality of nearly 500 kilometer of radius from surrounding 5
services offered by hospitals.[3] The amount of states in addition to local patients. Being the only
time a patient waits to be seen is one factor which hospital providing the Superspeciality services in
affects utilization of healthcare services. Patients government sector, a lot of patients visit hospital
perceive long waiting times as a barrier to actually every day. As hospital provide high quality
obtaining services.[4] Keeping patients waiting services at affordable price and with help of
unnecessarily can be a cause of stress for both government’s various initiatives major procedure
patient and doctor. Failure to incorporate are performed at low cost.
consumer-driven features into the design of wait As this hospital has several Superspeciality
experience could lead to patient and provider departments handling the patients in outpatient
dissatisfaction. department is really a challenging job. Daily
The Institute of Medicine (IOM) recommends nearly 2000 patients visit the outpatient
that, at least 90% of patients should be seen within department. As the OPD had a limited space
30 min of their scheduled appointment time.[5] which cannot be increase in immediate future and
This is, however, not the case in most developing due to large patient visiting the OPD there was
countries, as several studies have shown that

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long waiting which result in both patients and has been measured. Data regarding the number of
Doctors dissatisfaction and increase stress. patient visiting Outpatient department every day,
Prerequisite of the clinic management was, that their number in different department and other
according to the requirements of the ISO 9001: statistical information are collected from the
2000 certified quality management system of medical record section of the Hospital. The study
clinic[15.16,22,23,24] the appointment scheduling of area is Superspeciality Hospital Out Patient
the outpatients' department should be improved Department. This study was carried out between
with respect to efficiency and service quality. So, in February 2017 at the OPD of Multispecialty
the duty of the established interdisciplinary task Hospital in central India. The teaching hospital is
force was the systematic analysis of deficits in our one of the tertiary health institutions in the state
appointment scheduling practice by means of and acts as a referral for patients in the central
quality management measures. Inefficient India.
procedures had to be analyzed and improvements The hospital OPD timing is from 9.00am to 3.00
to be developed. Aim was to simplify scheduling pm, from Monday to Saturday and OPD was close
of patient appointments, to assign patients more on Sunday. OPD registration counter open at 8.30
purposefully to specialty consulting hours, and to am and the registration close at 2.00 pm. Due to
allow for more consultation time for patients and gradual increase in the number of patient visiting
referring doctors the like. Then these remedial the outpatient department there was a long waiting
measures had to be integrated into daily clinical period for patient for consultation with Doctor, for
routine. Finally the practicability of these investigations and further treatment resulting in
procedures had to be investigated. to conflict between the hospital staff and patients
resulting dissatisfaction among the patients,
Aims and Objective Doctor and hospital staff. This study was
1) To find the determinant of long waiting conducted to find the determinant of long waiting
period in OPD period in OPD and recommendation on reducing
2) To determine the patients satisfaction for waiting time in the out-patient department in a
OPD services Superspeciality hospital
3) To give recommendation on reducing The study was descriptive cross-sectional in
waiting time in the out-patient department design involving all patients seen at the OPD.
Structured questionnaire and waiting time
Material and Methods assessment card were used to elicit information on
This is a cross sectional observational study socio-demographic characteristics of patients,
conducted in a tertiary care Multi specialty time spent before registration, time spent in the
hospital after the ethical comity permission for waiting area, and time spent with a doctor, Time
conduction of this study. During the study both spend for investigation and time required for final
qualitative data like factors responsible for long consultation , total duration from hospital entry to
waiting time in OPD, its impact on patient exit of hospital is noted. Trained health personnel
satisfaction and quantitative data like average assisted respondents who could not read or write
waiting time of the patients in OPD, percent in completing the questionnaire.
distribution of satisfaction score given by the The questionnaire was given at entry of OPD of
patients has been collected. The data has been the hospital. Patients presenting to the OPD and
collected through face to face interview with the who gave their consent to participate in the study
help of semi- structured questionnaire and to were selected (inclusion criteria) while critically
estimate the average waiting time daily reporting ill patients were excluded from the study.
of in-time and out-time of patients coming in the

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The systematic sampling technique was carried 15) Any other suggestions for improvement
out by simple random sampling. The first patient Outpatient services.
visiting the registration counter was taken as Research Methodology
starting point and thereafter next patient The data generated were entered and analyzed
randomly selected who came for registration to using statistical package for social sciences
the OPD after the interval of 2 to 3 minutes, was version 17.0 (Chicago, IL, USA) and Microsoft
enrolled in the study if he give consent till 100 Excel 2007. Quantitative and qualitative statistical
patients was selected in each day. This data was variables were cross tabulated; Chi-square test
collect for 5 day (Monday to Friday) . The was used The level of statistical significance was
questioner was collected when the patient’s set at 95% confidence interval.
complete consultation was done. Out of total 500
patient selected for study 50 patient left hospital Observations and Results
without consultation and hence not included in The table no 1 shows the number of patients
further analysis, so the sample size became 450. arriving in OPD of various departments on
The statistical data was obtained from medical different weekday. It was observed that on
record section of hospital regarding total number Monday and Tuesday more patient visit the
of OPD registration and their demographic outpatient department as compare to weekend like
characteristics. Saturday. On an average all department have large
Questionnaire for OPD Patients :- number OPD patients. The Table 2 shows the
1) Did it is the 1st visit or revisit for OPD demographic data of patients, out of total 450
2) Time of arrival in OPD patient interview 56.88% are male and 43.11%
3) Time taken from arrival to OPD female. Nearly 72.44 % patients were above 40
registration yrs of age and 44.44% was more the 60 yrs age.
4) How do you feel is the reception staff? From table No 3, it was observe that nearly
5) How much time it take from registration to 60.88% of patients coming in outpatient
first consultation? department are coming from out of the city from
6) At what time you were asked to report at the nearby location. Some patients come from
counter and when did you reach the OPD adjacent state and travelled more than 500 km for
reception? treatment at outpatient department. Table No 4
7) Did any staff brief you regarding the shows that more than 58.66% of patients are
workflow in OPD revisiting the hospital. It shows that patients had
8) How long you have been waiting in OPD? faith in services provided in outpatient
9) Did any information regarding waiting time department. From table no, 5 we observe that
in OPD was given to you, at the time of 79.64 % of patients spend more than 3 hours in
appointment? outpatient department from entry into hospital to
10) How much time it took for you to interact final consultation and maximum time spend for
with doctor after your arrival? registration and waiting for consultation. Whereas
11) What is your perception on waiting time in actual consultation time was negligible compare
the hospital? to total waiting time. According to table no 6
12) What is your perception on waiting time for maximum patients(81.55% feel need for
getting investgation done. improvement in outpatient service.. When it was
13) How much time it take from arrival to final asked on which part of service must be improve
consultation. the it was found that the waiting time in outpatient
14) What would you suggest to reduce waiting department was most distressing(73.33%) and its
time in OPD reduction was to be done on priority.

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Table no 1: Average numbers of patients visiting OPD of various departments on weekday
SN Department Mon Tue Wed Thurs Fri Satur
1 Neurosurgery 288 209 188 155 165 150
2 Neurology 256 235 176 155 145 169
3 Cardiology 180 204 179 207 188 176
4 CVTS 235 205 197 206 199 165
5 Nephrology 145 124 165 150 160 140
6 Urology 256 254 198 168 188 195
7 Gastro 205 187 167 210 166 189
Total 1565 1418 1270 1251 1211 1184

Table 2: Demographic data of Patients

Age Male (%) Female (%) Total
below 20 Yrs 27(4.5%) 15(3.33%) 42(9.33%)
21 to 40 yrs 46(10.22%) 36(8.00%) 82(18.22%)
40 to 60 yrs 81(18.00%) 45(10.00%) 126(28.00%)
above 60 yrs 102(22.66%) 98(21.77%) 200(44.44%)
Total 256(56.88%) 194(43.11%) 450(100.00%)

Table No 3:- Source of Patients

Location of Patients Number of Patients
LOCAL 176(39.11%)
OUT STATION 274(60.88%)

Table No 4: -Number of patients visiting 1st time

Type of patients Number of patients
New Registration 186(41.33%)
Old registration 264(58.66%)
Total 450(100.00%)

Table 5: Waiting times for various procedure in Outpatient department

component of the OPD Visit < 1hrs 1 - 2hrs 2-3 hrs > 3hrs
Time from Arrival to registration 176(39.64%) 88(18.02%) 20(4.5%) 16(3.62%)
Time to consultation 196(44.14%) 170(38.29%) 76(17.12%) 18(4.07%)
Time for investigation/Pharmacy 82(18.22%) 180(40.99%) 220(48.88%) 64(14.22%)
Total Duration time to Departure 0(0.00%) 12(2.70%) 134(30.18%) 352(79.64%)
Total 450(100%) 450(100%) 450(100%) 450(100%)

Table No: - 6 Patients response to service of Table No 7 Thing to improve Outpatient

Outpatient Department Department services
Response No of patients Topic No of Responder
Good 14(3.11%) In Clinical Managements 0(0.00%)
Satisfactory 32(7.11%) Increase registration counter 57(12.66%)
Average 37(8.22%) Increase consulting chamber 63(14.00%)
Need Improvement 367(81.55%) reducing waiting time in OPD 330(73.33%)
Total 450(100.00%) Total 450(100.00%)

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Discussion selected that came for registration to the OPD at
This study was under taken with main objectives the interval of 2 to 3 minutes, was enrolled in the
to determine the flow of patient and average time study if he give consent was enroll till 100
spent in the OPD, to identify the factors those are patients was selected in each day. This data was
responsible for high waiting time and to collect for 5 day. Out of total 500 patients selected
recommend appropriate suggestions to optimize for study 50 patient left hospital without
the waiting in OPD. consultation and hence not included in further
The study is conducted in a 350 bedded analysis, so the sample size became 450. The
Superspeciality hospital in central India. This statistical data was obtained from medical record
esteemed institute is well known for its multitude section of hospital regarding total number of OPD
of services. The hospital is equipped withal registration and their demographic characteristics.
modern technologies and rendering excellent The data generated were entered and analyzed
services at an affordable cost resulting in large using SPSS version 17.0 and Microsoft Excel
number of patient coming to outpatient 2007. Quantitative and qualitative statistical
department not only from city but from distance variables were cross tabulated; Chi-square test
of nearly 500 km. Analysis of data was done was used to compare proportions, whereas the
through tables and graphs showing the number of Student t-test was used to compare means. The
respondents and their respective percentage and level of statistical significance was set at 95%
percentage bar diagrams and pie diagram were confidence interval.
used for the interpretation of the results. The table number 1 shows that, all department
In this descriptive, cross-sectional study, study have large number of OPD patients. It can be
sample taken from the patients visiting outpatient observe from the table that 1200 to 1600 patients
department of Multispecialty hospital. Structured visit the seven department of hospital. On average
questionnaire and waiting time assessment card 200 to 250 patient visits daily to each department.
were used to elicit information on socio- To systematically manage such large patients
demographic characteristics of patients, time spent population hospital must equipped with modern
before registration, time spent in the waiting area, queue management system. The table number 2
and time spent with a doctor, Time spend for show 72.44 % patients were above 40 yrs of age
investigation and time required for final and 44.44% were more the 60 yrs age. As older
consultation, total duration from hospital entry to patients visiting the outpatient department they
exit of hospital is noted. Trained health personnel need the treatment on the priority. Table number 3
assisted respondents who could not read or write shows that nearly 60.88% of patients coming in
in completing the questionnaire. outpatient department are coming from out of the
The questionnaire was given at entry of OPD of city limit from nearby location. Some patients
the hospital. Patients presenting to the OPD and come from adjacent state and travelled more than
who gave their consent to participate in the study 500 km for treatment at outpatient department.
were selected (inclusion criteria) while critically The patient coming from distant location are
ill patients were excluded from the study. expect that all procedure like consultation ,
Approval to carry out the study was also obtained investigation, pharmacy and appointment for
from the ethical committee of the teaching admission if needed should be completed in one
hospital. visit only otherwise they may not have place stay
The systematic sampling technique was carried in city and may not afford it and force to stay in
out by simple random sampling. The first patients hospital corridor in night creating security concern
visiting the registration counter was the starting for hospital administration. These patients
point and there thereafter, one patient randomly hardship can be reduce by effective time

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management and reducing the waiting time. by using the six sigma approach. In addition to the
Table number 4 shows that than more than overall reduction in waiting time for cardiac medical
58.66% of patients are revisiting the hospital. It consultation significant reduction in waiting time for
shows that patients had faith in services provided getting the lab results was also achieved. As an off
by outpatient department. As is evident from the shoot of the study nine registration counters were
table no 5 , 79.64% of the patients had to wait for started, registration forms were modified, additional
more than 3 hours for a various procedure in OPD staff were appointed to handle the telephones in the
and 30.18% of patients waiting anywhere between Cardiology OPD and they were also taught basic
2 hours to three hours. No of patients visiting the telephone etiquette, dedicated biochemistry analyzer
outpatient could have their consultation within one was provided for the cardiology department and an
hour. This clearly indicates that majority of alert system was put in place for patients waiting for
patients had a long waiting time. The response more than one hour.
from patients questioner reflects their expectation Rafat mohebbifar, Edris hasanpoor et(19) al
to see doctor within 60 minutes of Registration. studied, outpatient waiting time in health services
In a study conducted by Irshad Rahim(17) in the and teaching hospitals in Iran by applying same
hospitals of Dhaka Bangladesh in the year 2007, models, they recommended that for reducing the
total waiting time for each outpatient from the waiting time hospital must use advance facility
registration process to the entry of the like electronic appointment systems via internet,
examination room was estimated to be 66 six sigma models and queuing theory.
minutes. He stated at the end that this duration of Form the above finding and revive of liturature we
time is very high and the managers of the hospital can definitely conclude that due to heavy patients
should undertake appropriate measures to reduce inflow in our outpatient department we need to
it. analyse and adopt variouse que management
It was found that routine lab test and ECG/CT / methods. Whether it's a time used for registration of
MRI/USG/2DEcho results are critical information patient, routine doctor's appointment, emergency
for a medical consultation. Patients were waiting for room treatment, laboratory/diagnostic test,
either the lab test or both lab test and other procedures, receiving the results of various tests,
investigation. The table number 6 clearly indicate waiting happens to just about everyone seeking
that maximum patients (81.55%) feel need for medical care. It's often one of the most frustrating
improvement in outpatient service. When it was parts about healthcare delivery system. Waiting
asked on which part of service must be improve times for elective care have been considered a
the it was found that the waiting time in outpatient serious problem in many health care systems since
department was most distressing(73.33%) and its it acts as a barriers to efficient patient flows. OPDs
reduction was to be done on priority. is considered as the window to hospital services and
Prof. Dinesh T.A(18) et al studied the method of a patient's impression of the hospital begins at the
reducing waiting time in outpatient services of OPD. This impression often influences the patient's
large university teaching hospital using a six sensitivity to the hospital and therefore it is essential
sigma approach. This papar presents the results of a to ensure that OPD services provide an excellent
project of improving the quality of services provided experience for customers. For improvement in the
in an outpatient department of an university hospital in services of outpatient department we can follow
in India. The project was conducted on the basis of six sigma approaches which consist of following 5
the six sigma methodology and aimed to reduce step approaches.
waiting times in outpatient cardiology office. From above discussion, reduction in the waiting
Significant reduction in waiting time was achieved in time in outpatient department is to be done
the outpatient services of the Cardiology department priority basis have following recommendations:-

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1) Introduce the queue management system leave without seeing a physician: The
in outpatient department in form of Token Toronto Hospital experience. Ann Emerg
system and computerize patient guiding Med. 1994;24:1092–6.
system. 5. O’Malley MS, Fletcher SW, Fletcher RH,
2) Reorganization of the outpatient Earp JA. Measuring patient waiting time in
department allotting different days of OPD a practice setting: A comparison of
for different department so that only two to methods. J Ambul Care Manage.
three department have outpatient clinical at 1983;6:20–7.
any working day. This will result in 6. Singh H, Haqq ED, Mustapha N. Patients’
allotting more consultation space for perception and satisfaction with health
department. care professionals at primary care facilities
3) Opening more registration counter and in Trinidad and Tobago. Bull World
consultation chamber in outpatient Health Organ. 1999;77:356–60. [PMCID:
department. PMC2557648] .
4) Making provision to accommodate the 7. Ofilli AN, Ofowve CE. Patient's
emergency and critical patient on priority, assessment of efficiency of services at a
but at same time it does not affect routine teaching hospital in a developing
patients. country. Ann Afr Med. 2005;4:150–3.
5) Introduction of hospital information 8. Ofilli AN, Ofowve CE. What patients
system and integration of investigation want: A content analysis of key qualities
report with consultation computer system. that influence patient satisfaction. J Med
6) Regular review and analysis of data. Pract Manage. 2007;22:255–61.
9. Dansky KH, Miles J. Patient satisfaction
Conclusion with ambulatory healthcare services:
From the finding of above studt it was clearly Waiting time and filling time. Hosp Health
indicate that maximum patients (81.55%) feel Serv Adm. 1997;42:165–77.
need for improvement in outpatient service and 10. Huang XM. Patient attitude towards
the waiting time in outpatient department was waiting in an outpatient clinic and its
most distressing (73.33%) and its reduction was to applications. Health Serv Manage
be done on priority to improve . Res. 1994;7:2–8.
11. Average ER. Reported by Associated
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