Self-Scheduling Process Efficiency and Utilization of Online Self-Scheduling of Lab Tests: A Retrospective Analysis of Self-Scheduled Appointments for COVID Testing

Abstract

Introduction: The COVID 19 pandemic increased the need for rapid and accurate diagnostic testing for COVID. When testing became available, a systems response was needed to efficiently accommodate the high-volume flow of patients who needed testing. Self-scheduling of COVID testing was developed to help patients safely and efficiently schedule their COVID testing online or with a mobile app.

Methods: We captured the counts of COVID test appointments, time patients spent in scheduling COVID test appointments, appointment lead times, and no-shows for COVID test appointments. For 17 months of self-scheduling, we retrospectively compared self-scheduling with the concurrent staff scheduling of COVID tests.

Results: From November 2020 through March 2022 there were 619 104 scheduled appointments for COVID testing with 22% (136 252) being self-scheduled. For asymptomatic self-scheduled COVID tests, accounting for 10.3% (63 605/619 104) of total COVID tests scheduled, median time to self-schedule was 3.1 min, interquartile range (IQR) [2.4,4.7]. For symptomatic self-schedulers accounting for 11.7% (72 647/619 104) of total COVID tests scheduled, the median time to self-triage and self-schedule was 5.8 min, IQR[4.3,8.9]. Self-scheduled COVID appointments increased to 44% (42 387/97 086) of the total COVID appointments during the peak month of January 2022. Median appointment lead time for symptomatic self-scheduled COVID test appointments was 6.6 h compared to 2.9 h (P < .0001) for symptomatic staff scheduled appointments. However, adjusting for the 24% (32 194/135 252) that self-scheduled during hours when testing was unavailable, the median appointment lead time for symptomatic self-scheduled patients dropped to 3.6 h. No-shows were 2.5% for self-scheduled appointments compared to 3.0% no-shows that were staff scheduled (odds ratio 0.83, P < .0001).

Conclusion: COVID testing was self-scheduled for a large percent of scheduled COVID tests, taking patients only a few minutes to complete. Self-scheduling use increased over time, associated with a decreasing use of staff scheduled appointments and lower no-shows.

Keywords: appointment access; covid-19; lab test; mobile app; online; online scheduling; patient appointment; patient portal; self-schedule; triage.

Figure 1.

Process flows for scheduling COVID tests. Self-scheduling and staff scheduling both had separate process flows for symptomatic and asymptomatic patients for a total of 4 different appointment processes. Process flows are numbered 1 through 4, and the process step sequence is added as a letter after the process flow number. The same letter indicates a similar process step for comparison between process flows. Red outlined process steps had completion times available to analyze.

Figure 2.

Counts of COVID test scheduling activity and nurse line COVID calls by month.

Figure 3.

Self-scheduled COVID tests, staff scheduled COVID tests, and nurse COVID triage calls as a percent of total scheduled COVID test appointments over time.

Figure 4.

Kaplan-Meier time to event. Cumulative percent of patients whose assessment for COVID test eligibility (triage or pre-schedule questions) were less than the minutes on the horizontal axis. Corresponds to time in process flow steps 1B, 2B, and 3B in Figure 1.

Figure 5.

Kaplan-Meier time to event. Cumulative percent of COVID tests scheduled where appointment lead times were less than or equal the hours on the horizontal axis.

Figure 6.

Kaplan-Meier time to event, adjusted. Cumulative percent of COVID tests where appointment lead times were less than or equal the hours on the horizontal axis. Appointment lead times were adjusted for self-scheduling during hours when COVID testing was not available (see Methods: Appointment Lead Time Adjustment).