1
|
Kallos A, Perez A, O'Neill MG, Holt NL, Bruce A, Childs M, Kane Poitras S, Kherani T, Ladha T, Majaesic C, Ball GDC. Recommendations from parents, administrative staff and clinicians to improve paediatric ambulatory appointment scheduling. Child Care Health Dev 2021; 47:834-843. [PMID: 34169559 DOI: 10.1111/cch.12891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 01/28/2021] [Accepted: 06/17/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Stakeholders can provide valuable input to improve scheduling paediatric ambulatory clinic appointments, a complex process that requires effective planning and communication between parents, administrative staff and clinicians. The purpose of our study was to characterize recommendations from parents, administrative staff and clinicians to improve paediatric ambulatory appointment scheduling. METHODS Conducted between February 2018 and January 2019, this qualitative study was guided by qualitative description. Data collection was completed using focus groups with three stakeholder groups: parents, administrative staff and clinicians. Participants provided recommendations to optimize paediatric ambulatory appointment scheduling at the Stollery Children's Hospital in Edmonton, Alberta, Canada. Focus group data were transcribed verbatim and analysed using manifest inductive content analysis. RESULTS Forty-six participants (mean age: 42.7; 87% female) participated in 12 focus groups. Parents (n = 11), administrative staff (n = 22) and clinicians (n = 13) made recommendations that were organized into two categories: appointment triaging and arranging. Triaging recommendations were related to appointment availability (e.g. providing alternatives to cancelling clinics with short notice) and waitlist management (e.g. developing clear and consistent policies regarding information flow and communication between clinics and administrative staff). Appointment arranging recommendations referred to booking (e.g. directly involving parents in the booking process), reminders (e.g. using text message reminders) and attendance (e.g. providing parents with a single point of contact who can provide the correct information about late and cancellation policies). Recommendations were similar across stakeholder groups. CONCLUSION Our findings showed congruent recommendations across stakeholder groups to address challenges with scheduling ambulatory appointments, many of which have the potential to be modified. Experimental research and quality improvement initiatives are needed to determine the feasibility, acceptability and effectiveness of stakeholder recommendations to improve triaging and scheduling paediatric ambulatory appointments.
Collapse
Affiliation(s)
- Alecia Kallos
- Three Hive Consulting, Edmonton, Alberta, Canada.,Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Arnaldo Perez
- School of Dentistry, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Marcus G O'Neill
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Nicholas L Holt
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Alberta, Canada
| | - Aisha Bruce
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Michelle Childs
- Stollery Children's Hospital, Alberta Health Services, Edmonton, Alberta, Canada
| | - Sarah Kane Poitras
- Stollery Children's Hospital, Alberta Health Services, Edmonton, Alberta, Canada
| | - Tamizan Kherani
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Tehseen Ladha
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Carina Majaesic
- Stollery Children's Hospital, Alberta Health Services, Edmonton, Alberta, Canada
| | - Geoff D C Ball
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| |
Collapse
|
2
|
Lewis AK, Taylor NF, Carney PW, Harding KE. Reducing the waitlist of referred patients in a medical specialist outpatient clinic: an observational study. J Health Organ Manag 2021; ahead-of-print. [PMID: 33274613 DOI: 10.1108/jhom-08-2020-0321] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE Long waitlists in outpatient clinics are a widely recognised problem. The purpose of this paper is to describe and report the impact of a waitlist reduction strategy for an epilepsy clinic. DESIGN/METHODOLOGY/APPROACH This observational study described the local impact of a methodical approach to tackling a long waiting list, using targeted strategies supported by a modest additional budget. The interventions were described using the template for intervention description and replication (TIDieR). FINDINGS Over an eight-month period, the waitlist for the epilepsy clinic was reduced from 599 to 24 patients without increasing the number of days until the next available appointment. Most referrals were removed from the waitlist without an appointment. Auditing revealed a high proportion of patients no longer required the service or referrals remained on the waitlist due to administration error. A short-term increase in clinic capacity of 51 extra appointments met the needs of the remaining waiting patients. The additional project funding invested in this process was AUD $10,500 and a time-limited amount of extra work was absorbed by using existing clinic resources. PRACTICAL IMPLICATIONS This waitlist reduction strategy resulted in a very small waitlist for the epilepsy clinic, which is now well placed to trial further interventions with the aim of sustaining the service with minimal waiting times. Not every referral on the waitlist, particularly the very long waiters, required an appointment. Other outpatient clinics may be able to apply this process to reduce their waitlists using a modest budget. ORIGINALITY/VALUE Although there are reports of successful waitlist reduction, few report the intervention in detail. Use of the TIDieR in reporting enables the intervention to be appraised or adapted to other settings where long waitlists are problematic. Considerations related to implementation of policy are discussed and in this case, a locally led and executed change management strategy was a key to achieving the result.
Collapse
Affiliation(s)
- Annie K Lewis
- Eastern Health, Melbourne, Australia.,La Trobe University - Bundoora Campus, Melbourne, Australia
| | - Nicholas F Taylor
- Eastern Health, Melbourne, Australia.,La Trobe University - Bundoora Campus, Melbourne, Australia
| | - Patrick W Carney
- Eastern Health, Melbourne, Australia.,Monash University, Melbourne, Australia
| | - Katherine E Harding
- Eastern Health, Melbourne, Australia.,La Trobe University - Bundoora Campus, Melbourne, Australia
| |
Collapse
|
3
|
Mutsekwa R, Ostrowski S, Canavan R, Ball L, Angus R. Health service usage and re-referral rates: comparison of a dietitian-first clinic with a medical specialist-first model of care in a cohort of gastroenterology patients. Frontline Gastroenterol 2020; 12:175-181. [PMID: 33912331 PMCID: PMC8040499 DOI: 10.1136/flgastro-2020-101435] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 04/10/2020] [Accepted: 04/19/2020] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND The dietitian-first gastroenterology clinic (DFGC) is an expanded scope of practice initiative implemented in response to increased gastroenterology specialist demand. This study examined re-referral rates to gastroenterology and overall health service usage up to 24 months post management in DFGC compared with a traditional, gastroenterology specialist-first model. METHODS Patients discharged from DFGC in the first year were matched with those seen in the traditional model. Demographic, clinical and process-related service characteristics were compared, and logistic regression analysis was undertaken to model re-presentation and model of care (MoC) as the variable of interest considering covariates in univariate analyses. Analyses were performed at 12, 18 and 24 months post discharge. RESULTS The DFGC (122 patients) and traditional-model (62 patients) cohorts had similar baseline demographic characteristics. Wait-times (68.6 vs 272.9 days; p<0.001), treatment-times (89.4 vs 259.9 days; p<0.001) and usage of other services (1.4 vs 2.1 specialities; p=0.01) were lower in DFGC. Re-referral rates were low in both DFGC and traditional models at 12 months (0.82% vs 1.61%), 18 months (2.46% vs 6.45%) and 24 months (4.91% vs 8.06%), respectively, with no significant difference between the models at any time point. CONCLUSION Most patients do not re-present for similar conditions within 2 years when managed in the DFGC or traditional medical model. Patients managed in DFGC have lower overall health service usage compared with patients managed in the traditional model. These findings support the safety and effectiveness of a DFGC model as one strategy to manage specialist gastroenterology service demands.
Collapse
Affiliation(s)
- Rumbidzai Mutsekwa
- Nutrition Department, Gold Coast Hospital and Health Service, Southport, Queensland, Australia,Centre for Applied Health Economics, Griffith University Faculty of Health, Gold Coast, Queensland, Australia
| | - Szymon Ostrowski
- Gastroenterology Department, Gold Coast Hospital and Health Service, Southport, Queensland, Australia
| | - Russell Canavan
- Gastroenterology Department, Gold Coast Hospital and Health Service, Southport, Queensland, Australia
| | - Lauren Ball
- Menzies Health Institute Queensland, Griffith University Faculty of Health, Gold Coast, Queensland, Australia,School of Allied Health Sciences, Griffith University Faculty of Health, Gold Coast, Queensland, Australia
| | - Rebecca Angus
- Nutrition Department, Gold Coast Hospital and Health Service, Southport, Queensland, Australia,School of Allied Health Sciences, Griffith University Faculty of Health, Gold Coast, Queensland, Australia
| |
Collapse
|
4
|
Lewis AK, Taylor NF, Carney PW, Harding KE. Specific timely appointments for triage to reduce wait times in a medical outpatient clinic: protocol of a pre-post study with process evaluation. BMC Health Serv Res 2019; 19:831. [PMID: 31718635 PMCID: PMC6852965 DOI: 10.1186/s12913-019-4660-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 10/21/2019] [Indexed: 11/10/2022] Open
Abstract
Background Managing demand for services is a problem in many areas of healthcare, including specialist medical outpatient clinics. Some of these clinics have long waiting lists with variation in access for referred people. A model of triage and appointment allocation has been developed and tested that has reduced waiting times by about a third in community outpatient services. This study aims to determine whether the model can be applied in the setting of a specialist medical outpatient clinic to reduce wait time from referral to first appointment. Methods A pre-post study will collect data before and after implementing the Specific Timely Appointments for Triage (STAT) model of access and triage. The study will incorporate a pre-implementation period of 12 months, an implementation period of up to 6 months and a post STAT-implementation period of 6 months. The setting will be the epilepsy clinic at a metropolitan health service in Melbourne. Included will be all people referred to the clinic, or currently waiting, during the allocated periods of data collection (total sample estimated n = 975). Data routinely collected by the health service and qualitative data from staff will be analysed to determine the effects of introducing the STAT model. The primary outcome will be wait time, measured by number of patients on the wait list at monthly time points and the mean number of days waited from referral to first appointment. Secondary outcomes will include patient outcomes, such as admission to hospital while waiting, and service outcomes, including rate of discharge. Analysis of the primary outcome will include interrupted time series analysis and simple comparisons of the pre and post-implementation periods. Process evaluation will include investigation of the fidelity of the intervention, adaptations required and qualitative analysis of the experiences of clinic staff. Discussion Prompt access to service and optimum patient flow is important for patients and service providers. Testing the STAT model in a specialist medical outpatient clinic will add to the evidence informing service providers and policy makers about how the active management of supply and demand in health care can influence wait times. The results from this study may be applicable to other specialist medical outpatient clinics, potentially improving access to care for many people.
Collapse
Affiliation(s)
- Annie K Lewis
- Allied Health Clinical Research Office and Department of Neurosciences, Eastern Health, 5 Arnold St, Box Hill, Victoria, 3128, Australia. .,School of Allied Health, Health Services and Sport, La Trobe University, Kingsbury Drive, Bundoora, Victoria, 3086, Australia.
| | - Nicholas F Taylor
- Allied Health Clinical Research Office and Department of Neurosciences, Eastern Health, 5 Arnold St, Box Hill, Victoria, 3128, Australia.,School of Allied Health, Health Services and Sport, La Trobe University, Kingsbury Drive, Bundoora, Victoria, 3086, Australia
| | - Patrick W Carney
- Allied Health Clinical Research Office and Department of Neurosciences, Eastern Health, 5 Arnold St, Box Hill, Victoria, 3128, Australia.,Neurosciences, Monash University, 21 Chancellors Walk, Clayton, Victoria, 3800, Australia.,The Florey Institute for Neuroscience and Mental Health, Melbourne Brain Centre, Burgundy Street, 3084, Heidelberg, Australia
| | - Katherine E Harding
- Allied Health Clinical Research Office and Department of Neurosciences, Eastern Health, 5 Arnold St, Box Hill, Victoria, 3128, Australia.,School of Allied Health, Health Services and Sport, La Trobe University, Kingsbury Drive, Bundoora, Victoria, 3086, Australia
| |
Collapse
|
5
|
Naiker U, FitzGerald G, Dulhunty JM, Rosemann M. Time to wait: a systematic review of strategies that affect out-patient waiting times. AUST HEALTH REV 2019; 42:286-293. [PMID: 28355525 DOI: 10.1071/ah16275] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Accepted: 02/01/2017] [Indexed: 11/23/2022]
Abstract
Objective Out-patient waiting times pose a significant challenge for public patients in need of specialist evaluation and intervention. The aim of the present study was to identify and categorise effective strategies to reduce waiting times for specialist out-patient services with a focus on the Australian healthcare system. Methods A systematic review of major health databases was conducted using the key terms 'outpatient*' AND 'waiting time', 'process*' AND 'improvement in outpatient clinics'. Identified articles were assessed for their relevance by sequential review of the title, abstract and full text. References of the selected manuscripts were scanned for additional relevant articles. Selected articles were evaluated for consistent and emerging themes. Results In all, 152 articles were screened, of which 38 were included in the present review. Numerous strategies identified in the articles were consolidated into 26 consistent approaches. Three overarching themes were identified as significantly affecting waiting times: resource realignment, operational efficiency and process improvement. Conclusions Strategies to align resources, increase operational efficiency and improve processes provide a comprehensive approach that may reduce out-patient waiting times. What is known about the topic? Out-patient waiting times are a challenge in most countries that seek to provide universal access to health care for all citizens. Although there has been extensive research in this area, many patients still experience extensive delays accessing specialist care, particularly in the public health sector. The multiple factors that contribute to bottlenecks and inefficiencies in the referral process and affect patient waiting times are often poorly understood. What does this paper add? This paper reviews the published healthcare literature to identify strategies that affect specialist out-patient waiting times for patients. The findings suggest that there are numerous operational strategies that affect waiting times. These strategies may be categorised into three overarching themes (resource alignment, operational efficiencies and out-patient processes) that, when actioned in a coordinated approach, have the potential to significantly reduce out-patient waiting times. What are the implications for practitioners? This paper identifies evidence-based strategies for aligning resources, improving operational efficiency and streamlining processes, which may provide improvements to specialist out-patient waiting times for patients. Addressing the identified organisational, person-related, cultural and attitudinal factors will assist health system managers and health practitioners target the most appropriate improvement activities to reduce waiting times.
Collapse
Affiliation(s)
- Ugenthiri Naiker
- School of Public Health, Queensland University of Technology, Victoria Park Road, Kelvin Grove, Qld 4059, Australia. Email
| | - Gerry FitzGerald
- School of Public Health, Queensland University of Technology, Victoria Park Road, Kelvin Grove, Qld 4059, Australia. Email
| | - Joel M Dulhunty
- School of Public Health, Queensland University of Technology, Victoria Park Road, Kelvin Grove, Qld 4059, Australia. Email
| | - Michael Rosemann
- School of Information Systems, Science and Engineering Faculty, Queensland University of Technology, 2 George Street, Brisbane, Qld, 4000. Email
| |
Collapse
|
6
|
Bartlett M, Blazer S, Hobson G, Abbs I. The power of digital communications: improving outpatient attendances in south London. Future Healthc J 2018; 5:43-46. [PMID: 31098531 PMCID: PMC6510049 DOI: 10.7861/futurehosp.5-1-43] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Missed appointments represent a significant burden to healthcare budgets. The average 'did not attend' (DNA) rate across the NHS is 6.7%; however, significant variation can be observed. In 2015, Guy's and St Thomas' NHS Foundation Trust observed a DNA rate of 13.5% and partnered with DrDoctor to reduce this by implementing their innovative outpatient scheduling and booking platform. The overall rate has reduced by 17.2%; Guy's and St Thomas' NHS Foundation Trust has estimated a £2.6 million financial benefit in the first year and 91% of patients would recommend the service. This case study describes the onboarding process for DrDoctor's platform across Guy's and St Thomas' NHS Foundation Trust, the benefits delivered and next steps for the partnership.
Collapse
Affiliation(s)
| | | | | | - Ian Abbs
- Guy's and Saint Thomas’ NHS Foundation Trust, London, UK
| |
Collapse
|
7
|
Abstract
OBJECTIVE The proposal is to demonstrate that facelift surgery is particularly suitable for the care in ambulatory. METHODS Between 2010 and 2016, 246 patients were operated for a facelift in ambulatory. RESULTS No major complication arose in this series (241). Among the patients, 98% expressed their satisfaction and would accept again this intervention in ambulatory. CONCLUSION The facelift can be realized in ambulatory with complete safety. The rate of satisfaction shows a very strong support of the patients for the ambulatory care.
Collapse
|
8
|
Beaussier M, Albaladejo P, Sciard D, Jouffroy L, Benhamou D, Ecoffey C, Aubrun F. Operation and organisation of ambulatory surgery in France. Results of a nationwide survey; The OPERA study. Anaesth Crit Care Pain Med 2017; 36:353-357. [PMID: 28826981 DOI: 10.1016/j.accpm.2017.07.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Revised: 07/21/2017] [Accepted: 07/21/2017] [Indexed: 11/28/2022]
Abstract
Operation and organisation of ambulatory surgical activity in France remains largely undocumented. This nationwide observational prospective survey, carried out between December 2013 and December 2014, was undertaken to characterise the organisational processes of ambulatory surgery in France. Three hundred centres were randomly chosen from a list of 891 hospitals practicing ambulatory surgery, with stratification according to the type of facility (public general hospital, university hospital, private hospital) and region. An email was sent to the board of the randomly chosen facilities with an attached information letter explaining how the survey worked. Hospitals who did not reply to this email were contacted by phone. Among the 206 hospitals that answered the survey, 92 were private, 78 were public and 36 were university hospitals. Median accommodation capacities of ambulatory units were 8 beds, mostly distinct from conventional surgical ward. Patient pathways dedicated to ambulatory surgery appear as the current predominant practice. 77% of the French ambulatory units have a head nurse in charge of logistics and coordination. Several items still have to be improved, such as the adherence to modern fasting rules and the unnecessary use of stretcher to move the patient. Objective discharge score is used in 77% of ambulatory units. This survey highlights the implementation of some positive organisational parameters corresponding to common good practices recommendations. In contrast, several other recommendations are still insufficiently applied and may hamper the development of safe ambulatory surgery. This brings up new challenges for health regulatory boards, hospitals and ambulatory units managers.
Collapse
Affiliation(s)
- Marc Beaussier
- Department of anaesthesiology, institut mutualiste Montsouris, Paris, France.
| | - Pierre Albaladejo
- Department of anaesthesiology and intensive care medicine, Grenoble university hospital, Grenoble, France
| | - Didier Sciard
- Department of anaesthesiology, institut mutualiste Montsouris, Paris, France
| | | | - Dan Benhamou
- Department of anaesthesiology and intensive care medicine, groupe hospitalier et faculté de médecine Paris Sud, hôpital Bicêtre, AP-HP, Le Kremlin-Bicêtre, France
| | - Claude Ecoffey
- Department of anaesthesiology and intensive care medicine, Rennes university hospital, Rennes, France
| | - Frederic Aubrun
- Department of anaesthesiology and intensive care medicine, La Croix-Rousse university hospital, hospices civils de Lyon, Lyon, France
| | | |
Collapse
|
9
|
Dimovska E, Sharma S, Trebble T. Evaluation of patients’ attitudes to their care during oral and maxillofacial surgical outpatient consultations: the importance of waiting times and quality of interaction between patient and doctor. Br J Oral Maxillofac Surg 2016; 54:536-41. [DOI: 10.1016/j.bjoms.2016.02.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Accepted: 02/16/2016] [Indexed: 10/22/2022]
|
10
|
|
11
|
Patwardhan A, Henrickson M, Laskosz L, DuyenHong S, Spencer CH. Current pediatric rheumatology fellowship training in the United States: what fellows actually do. Pediatr Rheumatol Online J 2014; 12:8. [PMID: 24507769 PMCID: PMC3922187 DOI: 10.1186/1546-0096-12-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Accepted: 02/04/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pediatric Rheumatology (PR) training in the US has existed since the 1970's. In the early 1990's, the training was formalized into a three year training program by the American College of Graduate Medical Education (ACGME) and American Board of Pediatrics (ABP). Programs have been evaluated every 5 years by the ACGME to remain credentialed and graduates had to pass a written exam to be certified. There has been no report yet that details not just what training fellows should receive in the 32 US PR training programs but what training the trainees are actually receiving. METHODS After a literature search, a survey was constructed by the authors, then reviewed and revised with the help members of the Executive Committee of the Rheumatology Section of the American Academy of Pediatrics (AAP) using the Delphi technique. IRB approval was obtained from the AAP and Nationwide Children's Hospital. The list of fellows was obtained from the ABP and the survey sent out to 81 current fellows or fellows just having finished. One repeat e-mail was sent out. RESULTS Forty-seven fellows returned the survey by e-mail (58%) with the majority being 3rd year fellows or fellows who had completed their training. The demographics were as expected with females > males and Caucasians> > non-Caucasians. Training appeared quite appropriate in the number of ½ day continuity clinics per week (1-2, 71%), number of patients per clinic (4-5, 60%), inpatient exposure (2-4 inpatients per week, 40%; 5 or greater, 33%), and weekday/weekend call. Fellows attended more didactic activities than required, had ample time for research (54% 21-60/hours per week), and had multiple teaching opportunities. Seventy-seven percent of the trainees presented abstracts at national meetings, 41% had publication. Disease exposure was excellent and joint injection experience sufficient. CONCLUSIONS Most US PR training programs as a whole provide an appropriate training by current ACGME, American College of Rheumatology (ACR), and ABP standards in: 1) number of continuity clinics; 2) sufficient on-call activities for weekday nights and weekends; 3) joint interdisciplinary conferences; 4) electives 5) didactic activities; 6) scholarly activities; and 7) exposure to diverse rheumatology diseases. Areas of concern were uniformity & standardization of training, need for a customized PR training curriculum, more mentorship, free electives, training in musculoskeletal ultrasound, need for a hands-on OSCE certification exam and more exposure to ACGME competencies.
Collapse
Affiliation(s)
- Anjali Patwardhan
- Department of Child Health, University of Missouri Medical Center, Columbia, USA.
| | - Michael Henrickson
- Cincinnati Children’s Hospital/University of Cincinnati, Cincinnati, USA
| | - Laura Laskosz
- Manager, Committee and Sections, American Academy of Pediatric, Washington, USA
| | | | | |
Collapse
|
12
|
Thompson-Coon J, Abdul-Rahman AK, Whear R, Bethel A, Vaidya B, Gericke CA, Stein K. Telephone consultations in place of face to face out-patient consultations for patients discharged from hospital following surgery: a systematic review. BMC Health Serv Res 2013; 13:128. [PMID: 23561005 PMCID: PMC3626714 DOI: 10.1186/1472-6963-13-128] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2012] [Accepted: 03/25/2013] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Routine follow-up following uncomplicated surgery is being delivered by telephone in some settings. Telephone consultations may be preferable to patients and improve outpatient resource use. We aimed to compare the effectiveness of telephone consultations with face to face follow-up consultations, in patients discharged from hospital following surgery. METHODS Seven electronic databases (including Medline, Embase and PsycINFO) were searched from inception to July 2011. Comparative studies of any design in which routine follow-up via telephone was compared with face to face consultation in patients discharged from hospital after surgery were included. Study selection, data extraction and quality appraisal were performed independently by two reviewers with consensus reached by discussion and involvement of a third reviewer where necessary. RESULTS Five papers (four studies; 865 adults) met the inclusion criteria. The studies were of low methodological quality and reported dissimilar outcomes precluding any formal synthesis. CONCLUSIONS There has been very little comparative evaluation of different methods of routine follow-up care in patients discharged from hospital following surgery. Further work is needed to establish a role for telephone consultation in this patient group.
Collapse
Affiliation(s)
- Jo Thompson-Coon
- PenCLAHRC, University of Exeter Medical School, University of Exeter, Veysey Building, Salmon Pool Lane, Exeter, EX2 4SF, UK
| | - Abdul-Kareem Abdul-Rahman
- PenCLAHRC, University of Exeter Medical School, University of Exeter, Veysey Building, Salmon Pool Lane, Exeter, EX2 4SF, UK
| | - Rebecca Whear
- PenCLAHRC, University of Exeter Medical School, University of Exeter, Veysey Building, Salmon Pool Lane, Exeter, EX2 4SF, UK
| | - Alison Bethel
- PenCLAHRC, University of Exeter Medical School, University of Exeter, Veysey Building, Salmon Pool Lane, Exeter, EX2 4SF, UK
| | - Bijay Vaidya
- Department of Endocrinology, Royal Devon & Exeter Hospital NHS Foundation Trust, Exeter, EX2 5DW, UK
| | - Christian A Gericke
- PenCLAHRC, National Institute for Health Research, Peninsula College of Medicine and Dentistry, University of Plymouth, Portland Square, Plymouth, PL4 8AA, UK
- The Wesley Research Institute and Queenland University of Technology, Brisbane, QLD, 4068, Australia
| | - Ken Stein
- PenCLAHRC, University of Exeter Medical School, University of Exeter, Veysey Building, Salmon Pool Lane, Exeter, EX2 4SF, UK
| |
Collapse
|
13
|
Abstract
BACKGROUND Out-patient clinics offer trainees one of the most varied clinical experiences within the hospital setting, but they are often chaotic and over-stretched, with limited time for teaching. An awareness of how to improve this learning environment by both trainers and trainees may enhance learning opportunities. CONTEXT Clinical supervisors need to balance educational and service commitments, while maintaining a high quality of patient care. Supervision features observation and the sharing of clinical and continual feedback, which can improve clinical performance. Trainers must closely monitor the abilities of the trainee and gradually increase their responsibility and clinical load. INNOVATION The application of learning theory to the workplace can improve learning opportunities. Trainers should have some control over the environment, both the physical attributes (room availability, staffing levels and allocated consultation time) and the harder to measure aspects, such as the ethos of the department and attitudes to teaching. The creation of a community of practice within out-patient clinics can strengthen both the collective knowledge of the team and its role in treating patients. The active involvement of trainees within this social environment (for example, by performing independent consultations) validates their role in the care of patients and enhances their learning. IMPLICATIONS To maximise the learning opportunities within out-patient clinics there needs to be a shift in culture to promote learning in a safe and non-threatening environment. The establishment of a community of practice may validate the role of trainees in the management of patients and facilitate social learning by all members of the clinical team.
Collapse
Affiliation(s)
- James Williamson
- Department of General Surgery, Gloucestershire Royal Hospital, Gloucester, UK.
| |
Collapse
|
14
|
Abstract
OBJECTIVE To determine patient attitudes in gastroenterology outpatient care, including the preferences and expectations associated with satisfaction, waiting times and quality in the consultation. METHODS A service evaluation of patient care in outpatient gastroenterology clinics was carried out using a composite, dedicated self-completed questionnaire; this included demographics, preconsultation and postconsultation Likert scale attitudes to process, interactive and environmental factors and a 16-point ranking questionnaire of domains of the patient pathway considered important to obtaining satisfaction. RESULTS Two hundred and twenty-seven patients agreed to participate. The factors considered most important to obtaining satisfaction related to the quality of the consultation, including 'seeing the doctor', 'having confidence in the treatment plan', 'clear and appropriately set explanations', 'being listened to', 'opportunity to express important issues' and 'recognition of needs'. Low importance was attributed to process and environmental aspects including waiting times (appointment and waiting room), explanations for delays and the quietness and privacy of the consultation room, and involvement of the patient's next of kin. Patients reported dissatisfaction with long waiting times and short consultation times, but this did not appear to influence postconsultation satisfaction, the likelihood of reattendance or following the treatment plan. CONCLUSION Patients consider that factors most important to a satisfactory experience in gastroenterology outpatient care relate specifically to the quality of their interaction with their healthcare professional in consultation. The roles of environmental and process issues are considered less important.
Collapse
|
15
|
Zonderland ME, Boer F, Boucherie RJ, de Roode A, van Kleef JW. Redesign of a University Hospital Preanesthesia Evaluation Clinic Using a Queuing Theory Approach. Anesth Analg 2009; 109:1612-21. [DOI: 10.1213/ane.0b013e3181b921e7] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
16
|
Tsai CY, Wang MC, Liao WT, Lu JH, Sun PH, Lin BYJ, Breen GM. Hospital outpatient perceptions of the physical environment of waiting areas: the role of patient characteristics on atmospherics in one academic medical center. BMC Health Serv Res 2007; 7:198. [PMID: 18053239 PMCID: PMC2231355 DOI: 10.1186/1472-6963-7-198] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2007] [Accepted: 12/05/2007] [Indexed: 11/10/2022] Open
Abstract
Background This study examines hospital outpatient perceptions of the physical environment of the outpatient waiting areas in one medical center. The relationship of patient characteristics and their perceptions and needs for the outpatient waiting areas are also examined. Method The examined medical center consists of five main buildings which house seventeen primary waiting areas for the outpatient clinics of nine medical specialties: 1) Internal Medicine; 2) Surgery; 3) Ophthalmology; 4) Obstetrics-Gynecology and Pediatrics; 5) Chinese Medicine; 6) Otolaryngology; 7) Orthopedics; 8) Family Medicine; and 9) Dermatology. A 15-item structured questionnaire was developed to rate patient satisfaction covering the four dimensions of the physical environments of the outpatient waiting areas: 1) visual environment; 2) hearing environment; 3) body contact environment; and 4) cleanliness. The survey was conducted between November 28, 2005 and December 8, 2005. A total of 680 outpatients responded. Descriptive, univariate, and multiple regression analyses were applied in this study. Results All of the 15 items were ranked as relatively high with a range from 3.362 to 4.010, with a neutral score of 3. Using a principal component analysis' summated scores of four constructed dimensions of patient satisfaction with the physical environments (i.e. visual environment, hearing environment, body contact environment, and cleanliness), multiple regression analyses revealed that patient satisfaction with the physical environment of outpatient waiting areas was associated with gender, age, visiting frequency, and visiting time. Conclusion Patients' socio-demographics and context backgrounds demonstrated to have effects on their satisfaction with the physical environment of outpatient waiting areas. In addition to noticing the overall rankings for less satisfactory items, what should receive further attention is the consideration of the patients' personal characteristics when redesigning more comfortable and customized physical environments of waiting areas.
Collapse
Affiliation(s)
- Chun-Yen Tsai
- Institute of Health Service Administration, China Medical University, Taiwan.
| | | | | | | | | | | | | |
Collapse
|
17
|
|
18
|
Williams JG, Roberts SE, Ali MF, Cheung WY, Cohen DR, Demery G, Edwards A, Greer M, Hellier MD, Hutchings HA, Ip B, Longo MF, Russell IT, Snooks HA, Williams JC. Gastroenterology services in the UK. The burden of disease, and the organisation and delivery of services for gastrointestinal and liver disorders: a review of the evidence. Gut 2007; 56 Suppl 1:1-113. [PMID: 17303614 PMCID: PMC1860005 DOI: 10.1136/gut.2006.117598] [Citation(s) in RCA: 100] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/11/2006] [Indexed: 12/12/2022]
Affiliation(s)
- J G Williams
- Centre for Health Information, Research and EvaLuation (CHIRAL), School of Medicine, University of Wales, Swansea, UK
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
19
|
Chang SR, Chen YC, Chen KH. Actual time spent estimate--an index profile in management for pediatric outpatient care. Qual Manag Health Care 2006; 15:237-43. [PMID: 17047497 DOI: 10.1097/00019514-200610000-00005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES In this study we propose to develop and use an instrument to measure the individual actual time spent at each stop in an outpatient visit, on the basis of the perceived time spent and dissatisfaction level expressed by an accompanying adult (the subject) in a pediatric outpatient department. METHODS We shall use the exaggeration-appreciation level of the perceived time/actual time ratio as it relates to the subject's dissatisfaction level. This scheme allows for relationships between the exaggeration-appreciation level at each stop in the course of the visit and for the dissatisfaction levels for all stops prior to that one. Data were obtained from 191 of 197 randomly selected subjects visiting the pediatric outpatient department of a teaching hospital in Taiwan. RESULTS Geometric regression showed that the actual time spent per stop could be estimated on the basis of the perceived time and dissatisfaction level expressed by the subject at all stops up to the stop. CONCLUSIONS The index profile for the estimated actual time spent at each stop during a pediatric outpatient department visit can be generated from the perceived time for, and dissatisfaction with, each stop as expressed by the subjects. This profile may help the hospital managers evaluate the operation of the outpatient department and even provide the basis for adjustment of manpower.
Collapse
Affiliation(s)
- Shiow-Ru Chang
- School and Graduate Institute of Nursing, National Taiwan University, Taiwan.
| | | | | |
Collapse
|
20
|
Hale ED, Treharne GJ, Lyons AC, Norton Y, Mole S, Mitton DL, Douglas KMJ, Erb N, Kitas GD. "Joining the dots" for patients with systemic lupus erythematosus: personal perspectives of health care from a qualitative study. Ann Rheum Dis 2005; 65:585-9. [PMID: 16219711 PMCID: PMC1798117 DOI: 10.1136/ard.2005.037077] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To examine the perceptions of patients with systemic lupus erythematosus (SLE) about their health care provision in the United Kingdom. METHODS Semistructured interviews were conducted with 10 women aged 26 to 68 years who were diagnosed with SLE one to 12 years earlier. Interviews were audio recorded, transcribed verbatim, and analysed using interpretative phenomenological analysis to organise the themes of importance to participants. RESULTS Four themes emerged: diagnostic difficulties; understanding; communication; and integrated health care. Before diagnosis there was concern to appear legitimately ill and to have a label for the condition. After diagnosis participants still encountered health care professionals who were poorly informed about SLE. Family, friends, and employers did not understand the fluctuating nature of SLE, which often led to isolation. Participants felt that even health care professionals who specialised in SLE could not fully understand the psychosocial impact of the condition, and therefore did not provide information to meet those needs. Participants did not know which of the many health care professionals they had contact with to approach about their concerns. Lack of communication at an interdisciplinary level left them feeling that nobody was "joining the dots" for their health care. CONCLUSIONS Patients with SLE do not feel understood by health care providers or people close to them. Support from trained volunteers with SLE, as available at the open access lupus clinic in Dudley (West Midlands, UK), would ensure more adequate information from someone with personal experience. Such services may improve communication and help minimise SLE patients' isolation.
Collapse
Affiliation(s)
- E D Hale
- Department of Rheumatology, Dudley Group of Hospitals NHS Trust, Dudley DY1 2HQ, UK.
| | | | | | | | | | | | | | | | | |
Collapse
|