Variation in Patient Experience Across the Clinic Day: a Multilevel Assessment of Four Primary Care Practices

  • Lindsey M. PhilpotEmail author
  • Bushra A. Khokhar
  • Jordan K. Rosedahl
  • Tiffany A. Sinclair
  • Rajeev Chaudhry
  • Jon O. Ebbert
Original Research



Patient satisfaction with healthcare is associated with clinical outcomes, provider satisfaction, and success of healthcare organizations. As the clinic day progresses, provider fatigue, deterioration with communication within the care team, and appointment spillover may decrease patient experience.


To understand the relationship between likelihood to recommend a primary care practice and scheduled appointment time across multiple practice settings.


Retrospective cohort.


A retrospective cohort was created of all patients seen within four primary care practices between July 1, 2016, and September 30, 2017.

Main Measures

We looked at scheduled appointment time against patient likelihood to recommend a practice as a measure of overall patient experience collected routinely for clinical practice improvement by the Press Ganey Medical Practice Survey®. Adjusted mixed effects logistic regression models were created to understand the relationship between progressing appointment time on patient likelihood to recommend a practice. We constructed locally weighted smoothing (LOESS) curves to understand how reported patient experience varied over the clinic day.


We had a response rate of 14.0% (n = 3172), 80.2% of whom indicated they would recommend our practice to others. Appointment time scheduling during the last hour (4:00–4:59 PM) had a 45% lower odds of recommending our practice when compared to the first clinic hour (adjusted OR = 0.55, 95% CI 0.35–0.86) which is similar when controlling for patient-reported wait time (aOR = 0.59, 95% CI 0.37–0.95). LOESS plots demonstrated declining satisfaction with subsequent appointment times compared with the first session hour, with no effect just after the lunch hour break.


In primary care, appointment time of day is associated with patient-reported experience.


primary care patient experience surveys appointment time care team communication teamwork 


Funding Information

This study was funded by the Robert D. and Patricia E. Kern Center for the Science of Healthcare Delivery and the Mayo Clinic College of Medicine.

Compliance with Ethical Standards

This study was reviewed and approved by the Mayo Clinic Institutional Review Board. Patient consent was not required as data being collected for Mayo Clinic operational objectives were utilized, and under Minnesota law, patients providing authorization for participation in research utilizing existing medical data serves as consent.

Conflict of Interest

The authors declare that they do not have a conflict of interest.

Supplementary material

11606_2019_5336_MOESM1_ESM.pdf (1.2 mb)
ESM 1 (PDF 1257 kb)


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Copyright information

© Society of General Internal Medicine 2019

Authors and Affiliations

  • Lindsey M. Philpot
    • 1
    Email author
  • Bushra A. Khokhar
    • 1
  • Jordan K. Rosedahl
    • 1
  • Tiffany A. Sinclair
    • 1
  • Rajeev Chaudhry
    • 1
    • 2
  • Jon O. Ebbert
    • 1
    • 2
  1. 1.Robert D. and Patricia E. Kern Mayo Clinic Center for the Science of Health Care Delivery, Mayo ClinicRochesterUSA
  2. 2.Community Internal MedicineMayo Clinic College of MedicineRochesterUSA

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