• Kayode A Williams, Chester G Chambers, Maqbool Dada, Julia C McLeod, and John A Ulatowski.
• Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
• BMJ Open. 2014 May 15; 4 (5): e004679.

ObjectivesThe aim of this study was to examine the effects of an intervention to alter patient unpunctuality. The major hypothesis was that the intervention will change the distribution of patient unpunctuality by decreasing patient tardiness and increasing patient earliness.DesignProspective Quality Improvement.SettingSpecialty Pain Clinic in suburban Baltimore, Maryland, USA.ParticipantsThe patient population ranged in age from 18 to 93 years. All patients presenting to the clinic during the study period were included in the study. The average monthly volume was 86.2 (SD=13) patients. A total of 1500 patient visits were included in this study.InterventionsWe tracked appointment times and patient arrival times at an ambulatory pain clinic. An intervention was made in which patients were informed that tardy patients would not be seen and would be rescheduled. This policy was enforced over a 12-month period.Primary And Secondary Outcome MeasuresThe distribution of patient unpunctuality was developed preintervention and at 12 months after implementation. Distribution parameters were used as inputs to a discrete event simulation to determine effects of the change in patient unpunctuality on clinic delay.ResultsData regarding patient unpunctuality were gathered by direct observation before and after implementation of the intervention. The mean unpunctuality changed from -20.5 min (110 observations, SD=1.7) preintervention to -23.2 (169, 1.2) at 1 month after the intervention, -23.8 min (69, 1.8) at 6 months and -25.0 min (71, 1.2) after 1 year. The unpunctuality 12 months after initiation of the intervention was significantly different from that prior to the intervention (p<0.05).ConclusionsPhysicians and staff are able to alter patient arrival patterns to reduce patient unpunctuality. Reducing tardiness improves some measures of clinic performance, but may not always improve waiting times. Accommodating early arriving patients does serve to improve clinic performance.Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

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