'Telemedicine Untethered' Looks to Eliminate Virtual Waiting Room

UC San Diego Health borrows strategies from the restaurant and airline industries and text messages patients when their providers are available.

Staring at a blank computer screen while awaiting a telehealth consultation is not the best way to endear patients to virtual care.

With that in mind, providers at UC San Diego Health borrowed strategies used by the restaurant and airline industries and launched a 10-week pilot project that text messaged patients when their provider were available. The "telemedicine untethered" program proved so successful that the health system is expanding the option into various high-volume primary and surgical care clinics this summer.

Brett C. Meyer, MD, a neurologist and clinical director of telehealth at UC San Diego Health, led the pilot and said "the goal of the feasibility study was to determine if this flexibility lead to improved perception of waiting time and an enhanced experience, while assessing for time saving for both patients and providers."

Nearly two dozen patients from a stroke clinic participated in the study and were given the option of either getting a text with a visit link when their provider was ready or logging in at a scheduled time and waiting in front of a camera in a virtual waiting room.

After the 10-week pilot, the researchers found that no patients were seen late, while 55% were seen early, with an average 55-minute time savings in clinic operations due to patients being seen early. Study metrics also included demographics, visit rates, and satisfaction surveys. The results were published in Quality Management in Health Care.

"Providers are extremely interested in making clinic visits better and easier for our patients — especially in the event we are running late," Meyer said. “Our old patient-communication strategy was complicated by the fact that the device that we would call to inform of a delay was often the same device they were actively using for their video visit."

UC San Diego Health saw a 1000-fold increase in the rate of telemedicine visits during the pandemic, and telehealth volumes remain high, with more than 550,000 ambulatory telehealth visits seen at the health system since the start of the pandemic for all types of medical and surgical care needs.

Emily S. Perrinez, RN, MSN, MPH, study co-author and director of telehealth operations at UC San Diego Health, said the rise in the use of telehealth is prompting a re-evaluation of standard operating procedure.

"We stepped back and asked, 'Do we need a virtual waiting room at all? Can we let patients know when their provider is available instead of making them wait online?'" she said. "The reality is that wait times and lack of timely communication both correlate with patient experience. Real-time text notification that the provider is ready improved patient satisfaction, and this experience is the kind of feedback we love to see."

The bottom line for Meyer is about making life easier for patients and providers.

"As long as a patient has a smartphone handy, they can go about their day rather than waiting for the provider to join the video visit," he said. "For the provider, it definitely increases flexibility and may even increase throughput. Additionally, texting decreases the anxiety of a provider who may be running late. Knowing that we are not keeping a patient waiting is, in my mind, the most important thing. We respect that patients have obligations and their time is precious as well, and we don’t want to keep them waiting."