Patient waiting time in the outpatient clinic at a central surgical hospital of Vietnam: Implications for resource allocation

Introduction

Although patient waiting time has been defined as an important indicator in the assessment of healthcare quality¹ and patients’ satisfaction towards healthcare services^2,3, lengthy outpatient waiting time has posed a great challenge to maximize healthcare quality⁴. This issue is worse among countries with low provider-patient ratios⁵, and Vietnam is among highly populated countries that are fueled by patient overload, especially in the central hospitals⁶. Thus, extended waiting time has remained highly prevalent.

Previous study suggests that appropriate operation of medical examinations could shorten patient waiting times⁷. In Vietnam, attention has already been paid to the assessment of the length of medical examination. 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 minutes⁸. In 2012, a study by Le et al. conducted in outpatient clinic (Trung Vuong Emergency Hospital) suggested that the average time spent from registration to doctors’ conclusions was 246.87 ± 104.55 minutes (4.11 ± 1.7 hours)⁹. Accordingly, patient waiting time is influenced by various factors, such as working procedure, patient overload and appointment schedule^10,11.

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.

Methods

Results

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.

Discussion

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)⁸, Trung Vuong Emergency Hospital (Ho Chi Minh city)⁹, and Nguyen Trai Hospital (Ho Chi Minh City)¹². However, our findings were higher than studies by Vu at the National Hospital of Tropical Diseases (Hanoi City)⁷, and Cole in Australia¹³. 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 afternoon¹⁴. Thus, our study highlights the essential need for human resources enhancement, especially in the morning. Besides, health care providers should be well-distributed appropriately 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 time⁸. In fact, cumbersome administrative procedures related to health insurance remain the pressing issue in Vietnamese healthcare system¹⁵. Moreover, the government has planned to move toward universal health insurance, where 80% of the total population are covered by health insurance and reduce out-of-pocket health expenses to under 40% by 2020¹⁵. Since this strategy may be hampered by health insurance-related procedures, stakeholders should pay attention on simplifying administrative procedures for insured patients.

Conclusions

Our results provided evidence for authorities and stakeholders to create future interventions, in order to enhance patients’ satisfaction and the quality of healthcare services. Primarily, human resources promotion and distribution should be emphasized in outpatient clinics and health insurance-related administrative procedures should be simplified.

Data availability

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.d157112¹⁶