Impacts of unscheduled services on outpatient care

Abstract This article empirically studies the effects of unscheduled service on service efficiency and the quality of care using a data set from the outpatient clinic of a children's hospital located in China. At the clinic, physicians have discretion to admit walk‐in patients who are not scheduled in advance when all appointment slots are fully booked. Such unscheduled service is a form of capacity manipulation and helps mitigate the imbalance between supply and demand. However, it increases physicians' workload and its impact on the quality of care is not well understood. We employ an instrumental variable approach to quantify the causal impacts of unscheduled service on service efficiency and the quality of care. Unscheduled patients have significantly shorter average service time, characterized by fewer diagnostic tests and shorter face‐to‐face diagnostic time. Surprisingly, there is no evidence that the care quality, measured by the 30‐day hospitalization rate and the 7‐day revisit rate, is lower for unscheduled service compared with scheduled service. This result can be attributed to physicians' behavior in patient consultation and medication prescription. The implications of our results on workload management, capacity allocation, and long‐term capacity planning are discussed.