I. SUMMARY: Let’s leverage APEX and text messaging technologies to automatically reduce the anxiety and burden on patients and their caregivers currently caused by long waiting room time uncertainty!  

II. DESCRIPTION OF PROJECT:  One of the most common patient complaints in a number of clinic waiting rooms at UCSF are the long and uncertain waiting times to see their doctor. On average, wait times can be a minimum of 30 minutes up to 2 hours without any status updates to the waiting patients, causing high levels of patient frustration and anxiety to the point where patients leave unseen. Rather than discussing health issues with patients, our doctors and staff are faced with triaging anxious and angry patient complaints such as “I was afraid of missing my named being called but if I’d known how long the wait time was going to be I could have (a) used the restroom (b) gone to the cafeteria because I was starving (c) fed my meter but now I have a parking ticket”.   It has been difficult for front desk personnel or doctors to manually track and manually update patients on their wait-time statuses.  As a solution, we propose to develop “WAIT-INFO” a back-end application that utilizes APEX’s care management platform to (optionally) send automated free text message updates to patients with their estimated wait time and queue number. This will greatly reduce wait time uncertainty and provide freedom for patients to travel around.  As an example in ophthalmology, patient statuses in APEX are changed to a green circle after initial tech work-up, indicating they are now in the waiting room ready to be seen by their doctor. Wait time is often longest here. Our proposed WAIT-INFO application will utilize and track data (via color code system) from APEX to monitor patient’s wait time/queue status. Once the green circle is displayed in APEX an initial text message will be sent automatically to the patient. The first text message and subsequent messages are: "Thank you for your patience. There are currently #___ patient’s ahead (intervals >5, 5, 4, 3)".  Once the patient is #3 in the queue- the text will read: "Please return to the clinic immediately". If patients do not return to the clinic in time, they will be skipped but placed next in line.  An SMS “your patience is greatly appreciated” will then still be sent every 15 minutes, until the healthcare provider opens the chart ending all SMS alerts.  A manual override to text a patient to return to clinic can also be sent by the front desk.   

III. DELIVERABLES:  (a) Proof of value (completed!): In an already-completed pilot simulation using manually sent free SMS via txt.att.net,  “mock patients” (our team members) were followed through a real clinic schedule and responded to manually-sent SMS wait-time alerts. In this WAIT-INFO simulation, the estimated waiting room time was only 13 minutes (vs 46 minutes actual patient wait time in office).  (b)  Proof of concept:  One next step is a WAIT-INFO simulation manually monitoring and text messaging a cohort of waiting clinic patients as with the pilot study above, then surveying patients who did and did not participate in the WAIT-INFO simulation, comparing patient’s waiting-satisfaction, and gauging interest and feedback in an automated WAIT-INFO system.  From anecdotal evidence, we are confident patients will appreciate WAIT-INFO.  (c) WAIT-INFO application beta development: in parallel with step b above, the study team programmer will develop a beta version of the application that will use APEX as an automated means of gauging wait time, queueing patients, and sending text messages. (d) WAIT-INFO pilot testing and refinement: After steps b-c, we will refine in our clinic, extend and customize the application to a clinic in a second department, and then further refine for expansion at UCSF.

IV. IMPACTS: The proposed SMS WAIT app unites innovation and discovery to improve the patient and clinic staff experience and satisfaction all of which are UCSF’s foundations for quality patient care.  Just in ophthalmology alone, we estimate this would directly impact several thousand patients a month, as well as clinic staff.  Broader potential usage of this system includes wait-time alerts in other UCSF clinic and clinical lab waiting rooms with long uncertain wait times, or families waiting anxiously in surgical or maternity ward suites can be provided with SMS status updates of their loved ones. Front desk personnel could also leverage the system to manually send a text message to call patients to the front desk privately (a privacy improvement over the tradition of calling out a patient’s name in the waiting room).

V. PROJECT TEAM:   Jane Kuo, OD, FAAO (Team/clinical lead ~25 hours); Michael Deiner, PhD (Project manager ~25hours); Winnie Wat (APEX Analyst/WAIT-INFO developer ~35 hours).