Introduction: In obstetric triage, women who referred with obstetric complaints and those with acute or emergency situation are first evaluated. waiting time is one of the important factors that should be considered in the management and organization of the healthcare section. So far, the exact waiting time for emergency care and obstetric triage in Iran has not been estimated. Therefore, this study was performed with aim to determine mean waiting time for obstetrics triage in Tehran. Methods: This cross-sectional study was performed in 2018 on 9238 patients referred to obstetric triage of educational and medical hospitals in Tehran. Triage was actively performed using 5-level obstetric triage form (level 1: require immediate intervention, level 2: high risk requiring, levels 3: aassessment at the earliest opportunity, level 4: no acute problem, level 5: requires only one visit or consultation), In this research, a checklist containing personal, obstetrics, and also recording the time of triage and obstetric triage form was used. Data were analyzed by SPSS software (version 20) and descriptive statistical tests and ANOVA. P<0. 05 was considered statistically significant. Results: Mean total waiting time in morning, evening and night shifts were 22. 35 ± 3. 60, 18. 12 ± 3. 67 and 19. 15 ± 3. 67 min, respectively. ANOVA test showed no significant difference between mean waiting time based on working shifts per day (p = 0. 122) and month (p = 0. 473). Mean waiting time in level 2, 3, 4 and 5 of obstetric triage were 2. 73± 0. 40, 5. 3± 1. 13, 5. 76± 1. 69, 5. 96± 1. 20 min, respectively. Conclusion: Mean total waiting time for obstetric triage clients is somehow higher than the recommended rate. It is recommended to modify the process of service delivery to the clients of obstetrics triage in order to reduce the waiting time and achieve to the standard.

BACKGROUND: waiting time is an important indicator of patient satisfaction and the quality of care. The aim of this study is to determine the waiting time in physician offices in Tehran, Iran.METHODS: This was a cross-sectional study. The target population of this study consisted of specialist and subspecialist offices in Tehran. We used a census sampling method to study the population. Data of 5475 physicians was extracted from data banks, of which 43.4% were not accessible. Thus 3098 cases were included and analyzed. We conducted telephone interviews to gather data, which was subsequently analyzed using SPSS software.RESULTS: Out of the 3098 physicians interviewed, 2585 were specialists (83.4%); the remaining were subspecialists. The mean waiting time for a patient's first visit to a specialist was 4.30 days (SD=8.10) and for subspecialists it was 7.61 days (SD=13.98).DISCUSSION: The average waiting time in our study was less than a week for specialists and almost a week for subspecialists. The health system in Iran has not established a complete referral system and with this situation, waiting time may have adverse effects on the health of patients. Thus studying and managing waiting time in some medical specialties or regions is a priority in our country.

Objective(s): Providing a simulation model for understanding process and patient flow in outpatient clinics and estimating patients' waiting time.Methods: This was a descriptive study. In this study outpatient clinics of general teaching hospitals in Tehran were grouped according to statistical distribution of patients' arrival time and a sample of each group was selected. Then the data of arrival time, service time and flow of patient at clinic for 357 patients were collected. At last a simulation model of outpatient clinics was provided and validated.Results: Simulation model outputs showed that the mean patient waiting time for examination by novice resident was about 58 minutes, for experienced resident was about 52 minutes and for attend was about 53 minutes. Review of examination process with simulation model showed that about 42-62 percent of patients' waiting time for examination was before physician arrival at clinic. There were no statistical differences between new and follow-up patients' waiting time and waiting time for primary and complementary examination by residents and attend.Conclusion: We found that the time gap between patient admission and arrival of physician was the most important factor in rising outpatient waiting time. Efforts to lessening this time will decrease total waiting time for examination about 60 percent.

Introduction: Emergency department is one of the most important hospital wards that offers emergency services to unstable patients 24 hours a day, 7 days a week. However, the way the services are offered reflects the general status of the hospital since patients with the most serious problems frequently refer to the emergency department. Emergency department waiting time is one of the indices used in evaluating hospitals. Therefore, the present study aimed to determine emergency department waiting time and to provide appropriate strategies to reduce this time at Alzahra hospital during 2009.Methods: This was a descriptive, cross-sectional study. Observations and interviews were used to collect data. Ninety-seven patients were investigated. According to the objectives of the research, waiting time was assessed by a stopwatch, a checklist and patient records. The validity of the checklist was confirmed by the experts and hospital emergency officials. Descriptive and inferential statistics were used. The data was analyzed by SPSS.Results: The mean waiting time (from entrance to the emergency department until the final visit) in the screen was 8.41±5.19 minutes. About 74.2% of patients waited for less than 10 minutes.Patients had to wait for their order to be checked by the admission nurses, as the first clinical practice, for an average of 48.72±42.53 minutes. The mean waiting time from the physician’s order until admission to the paraclinical units including electrocardiography, radiography, CT scan, sonography and laboratory, was 59.2±46.26 minutes. The mean length of stay in the emergency department was 353.1±249.2 minutes. However, 39% of patients stayed less than 4 hours. T-test revealed significant relations between the type of disease (internal diseases, surgery) and waiting time at electrocardiography (P=0.02) and sonography (P=0.04) units.Conclusion: Since the screening was done for patients without any particular prioritization, it is necessary to establish a triage system in the emergency department of Alzahra hospital.Comparing mean waiting times to receive paraclinical services demonstrates the gap between the present status and available standards and highlights the serious need for paraclinical service process improvement. In order to prevent overcrowding, proper strategies are required to be used including prioritizing beds for emergency and non-emergency hospitalization, having an admissions coordinator, following the 30-minute rule, establishing a holding unit, direct admission of the patients, and scientific review of the number of CCU and ICU beds.

Objectives: The objective of this study was to provide a model for reducing outpatient waiting time by using simulation.Materials and Methods: A simulation model was constructed by using the data of arrival time, service time and flow of 357 patients referred to orthopedic clinic of a general teaching hospital in Tehran. The simulation model was validated before constructing different scenarios.Results: In this study 10 scenarios were presented for reducing outpatient waiting time. Patients waiting time was divided into three levels regarding their physicians. These waiting times for all scenarios were computed by simulation model. According to the final scores the 9th scenario was selected as the best way for reducing outpatient's waiting time.Conclusions: Using the simulation as a decision making tool helps us to decide how we can reduce outpatient's waiting time. Comparison of outputs of this scenario and the based- case scenario in simulation model shows that combining physician's work time changing with patient's admission time changing (scenario 9) would reduce patient waiting time about 73.09%.Due to dynamic and complex nature of healthcare systems, the application of simulation for the planning, modeling and analysis of these systems has lagged behind traditional manufacturing practices. Rapid growth in health care system expenditures, technology and competition has increased the complexity of health care systems. Simulation is a useful tool for decision making in complex and probable systems.  

The question of time has always been one of the greatest questions of philosophers and physicists throughout history. Undoubtedly, every philosophical thought is manifested in different forms in literary and artistic works, and among them there are writers and artists who use philosophy as the basis of their works. Samuel Beckett is one of the most influential writers in shaping the school of thought of Absurd Theater, which has its roots in philosophy. This article purports to examine and express the issue of time in the play waiting for Godot using the ideas of Martin Heidegger. Martin Heidegger looks at the question of "time" from an ontological point of view and in his divisions, he considers "time" in both original and non-original forms for Dasein (existence). As in the play waiting for Godot, the most important action of the play "the issue of time" is the characters' conflict in the form of two Dasein. Thus, according to Heidegger's definition of the original and non-original "time" with which Dasein is involved in life, "time" was examined as the most important element in the play waiting for Godot. To achieve this analysis, it was first necessary to provide an exhaustive definition of "time" in the philosophical thought of Heidegger and the philosophers before him, and then by examining the issue of wait and its meaning in Heidegger's "time", the play waiting for Godot and the characters' continuous wait were interpreted. Analytical research has been used in this study and by examining Heidegger's thoughts and Samuel Beckett's the play waiting for Godot, and using descriptive-analytical method, it has been tried to find the common ground between Beckett's thought on writing and performing the scenes of this play and Heidegger's philosophical thoughts to shed new light on its analysis and conducting.