The Health Minister Lyonpo Dechen Wangmo said that people are still not following the appointment system. She said that people delivering food and coming to see patients should avoid coming.
Lyonpo pointed out that vaccine cases, cancer and kidney patients and others requiring important care should continue coming.
The appointment system Jigme Dorji Wangchuck National Referral Hopsital (JDWNRH) was initiated to curb the issue of patients having to wait in long queues at the OPD to get checked by the doctors. It is especially important now to avoid exposure at the hospital due to COVID-19. There is also a walk-in provision for the people who do not know how to make an appointment. This is available in all the OPD departments except for the surgical department.
An official from the Quality Assurance and Standardization Division (QASD) said making an appointment can ease the over-crowding, but there are a few people who come before the appointment time to wait to see the doctors, and ultimately it gets over-crowded since there are also those patients who walk in. According to 2019 records maintained at JDWNRH, the hospital receives around 2,000 patients in a day.
The hospital makes constant efforts to sensitize the people on the appointment system to ease the patients visiting the hospital. Even one patient making an appointment would reduce over-crowding in the hospital. This will help everyone in social distancing and decongesting the hospital.
However, it was observed that the initiative has been a weak success due to various external and internal factors as per a survey done in 2019. There are also cases where the patients do not show up on the appointment time and then ask to be seen first because of an appointment made days ago, while the doctors have already taken in other patients.
There are also structural problems in the hospital as there needs to be a receptionist placed outside every chamber. The receptionist would be able to manage the over-crowding of patients.
A doctor in General OPD said there are many patients who come for mere headache and services has to be provided to them well because there is no alternative ways where they can go and get medicines. Therefore, the appointment system will not work in the General OPD, and people will not follow as well. So there is no appointment system in general OPD and it operates on token system like before.
There is also decrease in patients visiting the general OPD. On an average there are 200 patients in general OPD. 50 percent of the patients visiting JDWNRH are from other districts. Due to the COVID-19 fear, most of the patients from other districts have reduced, and only patients from Thimphu are seen visiting JDWNRH.
The doctor said if patients fixed an appointment, this will not only help in reducing over-crowding but also helps in providing quality services because doctors will also know how many patients they will seeing, and will be able to give each of them enough time. In the general OPD, doctors do not know how many patients they will be seeing.
As per the OPD Waiting Time Survey, December, 2019, though the patients availing themselves of the appointment service are given prompt service without having to wait, however, a high number of no shows and patients turning up late for their appointments have resulted in the doctors and other patients waiting for the tardy patients instead.
The survey shows that 22.02 percent of the total patients who were given appointments did not show up, increasing the percentage of patients seen before the appointment time to 38.45 percent.
Due to the factors, such as no shows and late shows, the appointment system is yet to achieve its highest efficiency. Although appointment efficiency is affected by the patient’s inability to show on time, there were also other factors affecting the system from the institution’s side.
JDWNRH is planning to send appointment reminders on phones because usually people who have fixed an appointment forget, and they also forget to inform the hospital that they cannot make it on the set appointment date and time. So at least, if there is a reminder pop-up, people might turn up, said the QASD official.
Another observation found in the study was that the receptionists were observed to be instructing the patients to get tokens the next day, in place of giving appointments. This shows the reluctance of the receptionists to support the initiative undermining the primary purpose of providing services to the patients without having to wait.
Sometimes this was based on the instructions from the HoDs in some departments due to inadequate number of doctors, the receptionists were asked not to give appointments and instead adjusted all the patients as walk-in to accommodate more patients. The inconsistency deterred people from making appointments.
Although the intentions may have been good, this directly hampers the whole idea behind appointment system where patients are supposed to call and make a time instead of having to wait, which coincidentally relates with the low appointment bookings in some departments, the official said.
The highest number of walk-in patients was recorded by Community Health Department whereas Gynecology/Obstetrics Department recorded the highest number of patients seen on appointment system.
The lowest walk-in patients (18) and patients on appointment (12) were seen by Forensic Department and Orthopedic Department respectively. For the 1,047 patients seen on appointment, the average OPD waiting time was 15 minutes 43 seconds and for the 6,586 walk-in patients, the average OPD waiting time was 51 minutes 53 seconds.
Psychiatry Department has the highest appointment waiting time at 31 minutes 43 seconds and Gynecology/Obstetric Department has the highest walk-in waiting time at 1 hour 54 minutes 22 seconds.
The Medical Department has recorded the lowest waiting time on appointment at 07 minutes 25 seconds and Psychiatric Department at 10 minutes 17 seconds for walk-in patients.
Hospital management recommended for a re-strategy of appointment system to increase its effectiveness, such as providing appointments on a daily basis to all the walk in patient based on reported consultation time to avoid no show and doctors without patients. If current appointment system is to be continued then the public needs to be re-sensitized on appointment system to reduce the no-shows and late shows which is greatly affecting the system.
Appointment contacts, both Bmobile and TashiCell, should be kept on active mode from 10 am to 3 pm from Monday to Friday and 10 am to 1pm on Saturday. Meanwhile, the off-hours appointment is temporarily stopped because most of the patients visiting during the off-hours were the ones applying for visas, and also to avoid exposure. The medical certificate is issued only on Monday and Thursday.