A modified walk-in system versus scheduled appointments in a secondary-care prosthetic and orthotic clinic

BACKGROUND: Waiting is common in health care, delays intervention, and has negative effects on satisfaction with services. OBJECTIVES: To evaluate effects of a modified walk-in system, where patients were invited consecutively from the waiting list to attend the clinic on a walk-in basis, on waiting times, services, and work environment. STUDY DESIGN: Parallel-group trial. METHODS: In all, 1286 consecutive patients in need of shoe insoles were randomized to waiting lists for modified walk-in (n = 655) or a scheduled appointment (n = 631). Seven staff members also participated. RESULTS: The median indirect waiting time to first appointment was 40 days shorter for modified walk-in (135 days) than for scheduled appointment (175 days; p < 0.001); 17% of those randomized to modified walk-in did not attend the clinic compared to 6% for scheduled appointment (p < 0.001). Mean direct waiting time in the waiting room was 9.9 min longer for modified walk-in than for scheduled appointment (p < 0.001). Patients attending modified walk-in or a scheduled appointment reported similar levels of satisfaction with services. Staff reported more support from co-workers with modified walk-in than with scheduled appointment (p = 0.041). CONCLUSION: The modified walk-in can reduce indirect waiting times without any substantial worsening of direct waiting times, service quality, or work environment. Studies are needed to investigate why many patients drop out from modified walk-in. CLINICAL RELEVANCE: A modified walk-in system can cut the queues and create more timely interventions by reducing indirect waiting times. This system can therefore be recommended in secondary-care prosthetic and orthotic clinics to reduce patients’ suffering from their health condition.