Reducing waiting time in outpatient department of Kaduha district hospital

Abstract

Background: The long waiting time in Outpatient Department (OPD) of Rwandan Public Hospitals is a common challenge for patients and to the healthcare providers. Prolonged waiting time is the common complaint for the patients and the source of dissatisfaction emanating from the delay of Hospital ambulatory services. The length of time a patient spends in a healthcare facility at each stage of admission to a healthcare provider and the total OPD time from arrival to departure influences satisfaction and quality of healthcare services provided. The aim of this study is to reduce patients waiting time at Outpatient Department of Kaduha District Hospital from four hundred fortyone minutes to two hundred and forty minutes by Mach 2022. Methods: A research project team was formed in October 2019 to investigate the causes of long waiting time and come up with a solution. A time study tool has been used to collect pre and post interventions data. A sample of 50 patients was selected using systematic simple random sampling before and after with the help of Kaduha DH Outpatient Department Staff. We measured the magnitude of the problem by calculating the process time and waiting time at each step where the patients could move seeking for the services in OPD. We conducted a root cause analysis using a fishbone diagram and the retained real root cause of long waiting time were the delay of outdated Humalyser machine to process the tests and insufficient medical doctors. This outdated machine could process results in two hours and thirty minutes per patient on average which caused the delay. For the insufficient number of Medical Doctors during second consultation, there was one Doctor instead of two. He could serve about fifty patients on average per day which is a huge workload for one Doctor according to the standards of the World Health Organization which stipulates that one Doctor should receive not later than 25 clients per day. In as far as the intervention was concerned, a modern machine known as COBAS which performs 106 lab exams in 30 minutes at once was bought and installed. Another medical staff was recruited in OPD to occupy the second consultation room which was also initiated. The interventions started in September 2021 and lasted for a period of five months and the evaluation was conducted in March 2022. Results: The results show that the total time in Kaduha DH OPD has been significantly reduced from four hundred and forty-one minutes (7 Hours and 21 Minutes) in pre intervention to three hundred and eleven minutes (5Hours and 11 Minutes) after intervention. Total waiting time for a patient was 6 hours and 06 minutes per day in pre interventions and this reduced to 3hours and 42 minutes in post interventions. Finally, process time for the patient increased from one hour and 16 minutes to one hour and 29 minutes per day. Conclusion: The problem of long waiting time in Kaduha District Hospital OPD can be addressed and patients attending OPD services can be satisfied with the services delivered if the problems of under-staffing, inadequate equipment, patient flow and respect of working hours and turnaround time (both process and Wait time) long waiting time can be managed. Hospital staff are recommended to start providing health services from morning at 7h : 00 am. Two medical consultations rooms should remain open and receive patients vi regular, the turn around time in Laboratory should be effectively managed. Finally, proper prescription procedures of laboratory exams and medications should be enhanced on time.