Background/objective: Long access time to computed tomography (CT) facilities is seen as a substantial problem in many hospitals. Walk-in is an intervention that eliminates access times, since it gives patients direct access without an appointment. The Rijnstate hospital implemented walk-in CT in 2010, which offered the opportunity to study the positive and negative effects of walk-in CT in practice and how these effects are balanced.
Material and methods: Employee interviews (N = 10), patient surveys (N = 535) and a data analysis using data from the Electronic Patient Record (EPR) of 129.148 patients between October 2008 and March 2017 were conducted.
Results: All stakeholders stated that the system improved with the introduction of walk-in. The interviews also resulted in main performance indicators: access time, waiting time, one-stop-shop, autonomy of choice, productivity and employee satisfaction. The patient survey divulged the maximum acceptable waiting time: 79% of patients stated this to be 15–30 minutes or more. When asked which performance indicator is most important, ‘one stop shop’ was mentioned by 134 patients over access time, waiting time and autonomy of choice (ranged from 79 to 88). The data analysis showed a doubling in production, while CT capacity hardly increased. The percentage of outpatients that had to wait 30 minutes or less has decreased from 85.2% in 2009 to 59.5% in 2016, but the absolute number of outpatients with these waiting times increased from 5.146 to 7.681. Overtime production regarding outpatients has decreased over the years.
Conclusions: Walk-in CT performs better regarding the main performance indicators than a full appointment system. The reasons are that it almost nullifies CT access time and enhances one-stop-shop for patients. Walk-in also improves satisfaction of patients, referring physicians as well as the entire radiology staff, technicians and doctors alike. Furthermore, all results suggest that productivity can be higher with walk-in than with only appointments.
- Access system
- Access time
- Operations management
- Patient preferences
- Process improvement
- Stakeholder approach
- n/a OA procedure