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Factors Associated With Timeliness in Academic General Surgery Clinics: A Prospective Quality Assessment

Katelyn A. Young, BS; D. Priyantha Devapriya, PhD; James T. Dove, BA; Marcus Fluck, BS; Kristy A. Yohey, MHS; Marie A. Hunsinger, RN, BSHS; John E. Widger, MD; Joseph A. Blansfield, MD; and Mohsen M. Shabahang
The participation of residents and physician assistants significantly increased patient wait time without reducing the attending surgeon’s consultation length in outpatient surgery clinics.
However, it should be noted that this study does not conclude that IPs should be removed from the surgical clinic. First, IPs contribute to clinic efficiency in many ways that were not quantified in this analysis, including pre- and post appointment documentation. Secondly, training in the clinic continues to be essential for surgical residents to graduate with the complete skillset necessary to run a surgical practice. Thirdly, previous investigations have found that patient satisfaction is not adversely affected by the involvement of these providers, particularly residents, and patients credit the involvement with increased interaction and enhanced education in the ambulatory setting.4,5 Additionally, AS consultation length has been consistently identified as a contributor to patient satisfaction across a wide spectrum of surgical and medical specialties in the outpatient clinic setting.2,6-8 Thus, although IP involvement was not associated with a decrease in the AS consultation length, patient satisfaction may in fact benefit from the increased provider interaction (IP and AS consultations) without a shortened consultation with the AS. In fact, one study found that time spent with the AS is a stronger predictor of satisfaction than examination room wait time.7 This reflects the multifactorial nature of patient satisfaction and the complex relationship between efficiency and satisfaction. 


This study is not without limitations. First, the infrequent participation of fellow surgeons makes generalizations regarding the effect of this particular population difficult. Secondly, clinic providers were not blinded to the observer’s presence, and it is possible that clinic staff altered their behavior during observation. To mitigate this potential effect, members of the study team assured all staff members that there were no incentives or penalties associated with performance. Nonetheless, to minimize this potential bias, future studies would need to have the start time of the AS consultation electronically captured in the health record. This prudent data capture would facilitate an objective measure of patient wait time for every clinic appointment, which would enable a more comprehensive view of OWT. 


Using time-flow observation, this prospective study found that provider- and appointment-specific factors, including clinician experience and appointment overbooking, were not associated with timeliness in outpatient surgery clinics. The involvement of an IP, however, was an independent contributor to longer OWT without reducing AS consultation length.

Author Affiliations: Geisinger Medical Center (KAYou, DPD, JTD, MF, KAYoh, MAH, JEW, JAB, MMS), Danville, PA.

Source of Funding: None. 

Author Disclosures: The authors report no relationship or financial interest with any entity that would pose a conflict of interest with the subject matter of this article.

Presentation: Poster: 2017 Annual Scientific Meeting, Southeastern Surgical Congress. Nashville, TN.

Authorship Information: Concept and design (KAYou, DPD, MF, KAYoh, MAH, JEW, JAB, MMS); acquisition of data (KAYou, DPD, MF, KAYoh, MAH, JEW, JAB, MMS); analysis and interpretation of data (KAYou, DPD, JTD, MF, KAYoh, MMS); drafting of the manuscript (KAYou, DPD, JTD, KAYoh, MAH, JAB, MMS); critical revision of the manuscript for important intellectual content (KAYou, DPD, KAYoh, MAH, JEW, JAB, MMS); statistical analysis (KAYou, DPD, JTD); provision of study materials or patients (KAYou, KAYoh, JEW, JAB); administrative, technical, or logistic support (KAYou, DPD, KAYoh, MAH, JEW, MMS); and supervision (MMS). 

Send Correspondence to: Mohsen M. Shabahang, MD, PhD, Geisinger Medical Center, 100 North Academy Ave, MC21-69, Danville, PA 17822-4910. E-mail: 

1. Waghorn A, McKee M. Understanding patients’ views of a surgical outpatient clinic. J Eval Clin Pract. 2000;6(3):273-279. 

2. Gibler J, Nyswonger G, Engel AM, Grannan K, Welling R. Improving satisfaction ratings of surgical patients from referral to follow-up in the faculty medical center clinic. J Surg Educ. 2011;68(5):360-364. doi: 10.1016/j.jsurg.2011.03.008.

3. Meza JP. Patient waiting times in a physician’s office. Am J Manag Care. 1998;4(5):703-712. 

4. O’Malley PG, Omori DM, Landry FJ, Jackson J, Kroenke K. A prospective study to assess the effect of ambulatory teaching on patient satisfaction. Acad Med. 1997;72(11):1015-1017.

5. Sheets KJ, Caruthers BS, Schwenk TL. Patient satisfaction with gynecologic care provided by family practice resident physicians. Fam Pract Res J. 1991;11(4):421-428.

6. Chung KC, Hamill JB, Kim HM, Walters MR, Wilkins EG. Predictors of patient satisfaction in an outpatient plastic surgery clinic. Ann Plast Surg. 1999;42(1):56-60.

7. Anderson RT, Camacho FT, Balkrishnan R. Willing to wait?: the influence of patient wait time on satisfaction with primary care. BMC Health Serv Res. 2007;7:31. doi: 10.1186/1472-6963-7-31.

8. Feddock CA, Bailey PD, Griffith CH, Lineberry MJ, Wilson JF. Is time spent with the physician associated with parent dissatisfaction due to long waiting times? Eval Health Prof. 2010;33(2):216-225. doi: 10.1177/0163278710361930.
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