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Exploring the lengthiest ambulatory breast surgery clinic appointments: is the patient the problem?
Daniel J Kagedan1, Kazuaki Takabe1,2
1Department of Surgical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA.
Insights
Longest breast surgery appointments are typically for new cancer patients. Most patients do not have consistently lengthy appointments, suggesting past long visits may not predict future ones.
Area of Science:
- Oncology
- Surgical Oncology
- Health Services Research
Background:
- Prolonged outpatient appointments disrupt patient and provider schedules.
- Understanding factors contributing to lengthy appointments is crucial for optimizing clinic operations.
Purpose of the Study:
- To identify characteristics of the longest ambulatory appointments in a breast surgery clinic.
- To determine if patients with historically long appointments consistently experience them.
Main Methods:
- Retrospective cohort study of 15,265 breast surgery appointments (January 2017-May 2019).
- Identified the longest 1% of appointments (n=148) using real-time tracking.
- Analyzed patient demographics, appointment types, and historical appointment duration patterns.
Main Results:
- The longest appointments averaged 264 minutes and were predominantly new patient visits (70%).
- Patients undergoing tests/investigations comprised 54% of these lengthy appointments.
- Only 26% of patients with multiple appointments had consistently protracted visits; 74% had sporadically protracted ones.
Conclusions:
- Lengthiest breast surgery appointments are associated with newly diagnosed cancer patients.
- A patient's history of a prolonged appointment does not reliably predict future lengthy visits.
- Interventions for appointment length should consider patient diagnosis and the nature of the visit.
Background:
Prolonged outpatient clinic appointments can disrupt schedules, impacting patients and providers. We sought to define features of the longest ambulatory appointments in a breast surgery clinic, and to ascertain whether patients attending these appointments consistently have protracted appointments.
Methods:
A single-institution retrospective cohort study was conducted of breast surgery clinic patients, January 2017 to May 2019, and the longest 1% of appointments identified using a real-time patient tracking system. A primary chart review was performed, and data abstracted. Other appointments attended by these patients were identified, and the ratio of appointments >75th percentile duration (protracted appointments) to the total appointments during the study period was calculated, enabling comparison for patients with consistently protracted (ratio >50%) vs. sporadically protracted appointments (≤50%). Descriptive analysis was performed, and results reported as medians with inter-quartile ranges.
Results:
A total of 15,265 clinic appointments were identified, and the longest 148 (exceeding 244 minutes) analyzed. Median appointment length was 264 minutes (inter-quartile range: 253-290). 70% were new patient appointments, and 54% of patients underwent a test/investigation that day. A minority were obese (39%), smokers (41%), diagnosed with a psychiatric comorbidity (34%), had a genetic cancer syndrome (22%), or received unexpected news at their appointment (16%). Of 118 patients with multiple appointments, 26% had consistently protracted appointments and 74% sporadically protracted appointments.
Conclusions:
The lengthiest appointments are usually newly diagnosed cancer patients. Only a minority of patients have consistently protracted appointments, implying that a patient's previously prolonged appointment may not predict future long appointments.
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