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Introduction: This study examined the association between the use of home nursing care and the consultation time of emergency home visits among patients using home health care. Methods: Participants were recruited from three urban clinics in Japan between September 1 and November 30, 2019. Univariate analysis and multivariate negative binomial regression analysis considering institutional clusters were performed on the relationship between the two. Results: A total of 278 patients were included in the analyses. The use of home nursing care was significantly associated with a decrease in the time spent during emergency home visits in both univariate and multivariate analyses (P < 0.018 and P < 0.001, respectively). The multivariate analysis estimated the mean reduction in consultation time to be 10.3 minutes (95% confidence interval, 9.9-10.8). Conclusion: The use of home nursing care reduced the consultation time in emergency home visits. This study suggested that home nursing care can reduce the burden on physicians providing home visits, but further studies are needed to improve collaboration.
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Background@#The COVID-19 pandemic has emphasized the critical task of the UP Health Service in recognizing and addressing the primary care needs of health care workers and support staff of the Philippine General Hospital. This helps in effective staff management and engendering trust in the hospital that performs critical functions in the pandemic response.@*Objectives@#To determine the service and waiting time in the facilities of the UPHS and describe good practices and areas for improvement for better service delivery at the UPHS during the COVID-19 pandemic@*Methods@#A cross-sectional study using patient flow analysis of processes in the non-COVID, COVID, and swabbing areas of the UPHS was conducted from June 1 to 5, 2020. All clinic visits by PGH employees and health care workers, including consultations and procedure for swabbing, were included in the study. Average service and waiting time in three areas of the UPHS were measured and analyzed from recorded time points using Microsoft Excel. Daily observations recorded on field notes were transcribed and analyzed using MaxQDA Analytics Pro 2020.@*Results@#A total of 604 PGH employee visits in the three main service areas of the UPHS were recorded during the 5-day study period. The average total service time was 25 (SD±17) minutes in the non-COVID clinic and 12 (SD±5) minutes in the COVID clinic. The mean swabbing time was 2 (SD±3) minutes. The average waiting time was longest in the COVID clinic at 46 (SD±39) minutes, followed by the swabbing area at 33 (SD± 32) minutes, and was shortest in the non-COVID clinic at 10 (SD±17) minutes. Good practices were observed in the areas of communication and coordination among the UPHS team, staff complementation, and application of telehealth solutions. Meanwhile, improvements may be made in identifying a practical and robust queuing system, enforcing firmer infection prevention and control measures and providing clearer patient instructions and cues especially during patient surge.@*Conclusion@#The average service time in the non-COVID, COVID and swabbing areas of the UPHS, were 25, 12 and 2 minutes, respectively. The average waiting time was longest in the COVID clinic, followed by the swabbing and non-COVID areas. Good practices were observed in terms of leadership, communication, staff complementation and feedback process while infection control and prevention measures, queuing system for crowd control and patient instructions can be further improved.
Subject(s)
Health Services , COVID-19ABSTRACT
Background: The doctor-patient relationship is the core foundation for healing, care, establishment of trust and an essential part of modern-day medical ethics. The last few decades have seen an exponential growth in the scientific component of the medical field which has led to a strain on doctor-patient relationship. With the growing trend of patients wanting more information from their doctor in order to have a more active role in their health-care, active communication from the physician’s end is needed. Present study aims to find out what doctors over various fields expect out of this relationship.Methods: A cross sectional prospective study was conducted among a total of 49 urban and rural doctors of various specialities in an urban area of Maharashtra using a pre-structured questionnaire. The statistical tools used to analyse the data was by using Microsoft excel software.Results: It was also noted that time spent with patients was less by the specialists as compared with other doctors for all aspects of consultation. On evaluating experience with the duration of consultation, we noted that doctors having more than 30 years of experience gave lesser time for all aspects of consultation as compared to those with lesser experience. A close range, between 45%-57% of all physicians, admitted to answering phone calls during consultations.Conclusions:It is imperative to study doctor-patient interactions since a better relationship results in a more satisfied patient with better treatment outcome.
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Mediano Riesgo es un servicio de atención ambulatoria del Hospital Garrahan. Se atienden pacientes con enfermedades prolongadas, que han realizado consultas en otros efectores de salud u otros servicios del Hospital, o que requieren segunda opinión o abordaje multidisciplinario. Objetivos: Mensurar el tiempo profesional invertido en la atención como herramienta para ponderar la complejidad de los pacientes. Identificar variables demográficas y del proceso de atención. Material y métodos: Investigación descriptiva, transversal sobre pacientes encuestados entre julio y diciembre de 2017 en el Sector de Mediano Riesgo. Se registraron: variables demográficas, proceso de atención, diagnósticos previos y finales, interconsultas, exámenes complementarios y tiempos de consulta profesional. Se tomó 65 minutos (mediana del tiempo profesional total) como punto de corte para definir dos grupos: tiempo de consulta corto o largo. Se realizó un análisis comparativo entre ambos. Resultados: se encuestaron 400 pacientes. Mediana de edad fue de 67,2 meses; 80,1% procedían de CABA y del GBA; mediana de duración del síntoma fue 4 meses; 25,8% tenía enfermedad de base; 62,5% fueron pacientes derivados (externos e internos); destino a pediatra zonal: 30%; interconsultas: 48,5%; tiempo total profesional: mediana 65 minutos (rango 12-460); diagnósticos simples: 37,2%. Variables con significación estadística para pertenecer al tiempo largo: número de diagnósticos finales, procedencia, diagnósticos no simples y presencia de enfermedad de base. Variables con tendencia a pertenecer a tiempo largo: duración del síntoma mayor de 1 mes, edad menor a 24 meses, patología tumoral, síndromes polimalformativos, abuso sexual infantil y problemas de lenguaje /aprendizaje. Conclusiones: el tiempo de consulta es un factor concurrente para la evaluación de la complejidad del proceso de atención. La identificación de variables que permitan preverlo es información relevante para la organización del sector, o de otros efectores de salud (AU)
The sector of Intermediate Risk is part of the outpatient clinics of Garrahan Hospital. In the sector patients with chronic diseases are seen, that have have consulted at other centers or other departments of the hospital, or that need a second opinion or a multidisciplinary approach. Objectives: To assess the professional time invested in care as a tool to evaluate the complexity of the patients, and to identify demographic variables and the care process. Material and methods: A cross-sectional, descriptive study on patients surveyed between July and December 2017 in the Sector of Intermediate Risk. The following data were recorded: Demographic features, care process, previous and final diagnoses, consultations, complementary studies, duration of the interview. A time of 65 minutes (median total time of the visit) was defined as the cut-off point to define two groups: Those with a long and a short interview. A comparative analysis was performed comparing both groups. Results: 400 patients were surveyed. Median age was 67.2 months; 80.1% were form the city of Buenos Aires and Greater Buenos Aires. Mean symptom duration was 4 months; 25.8% had an underlying disease; 62.5% of the patients was referred (either external or internally); referred by the local pediatrician: 30%; second opinions: 48,5%; total time of the interview: median 65 minutes (range, 12-460); simple diagnoses: 37.2%. Statistically significant variables for a long interview were: number of final diagnoses, place of origin, complicated diagnoses, and presence of underlying disease. Variables with a trend to a long interview were: symptom duration more than one month, age less than 24 months, a diagnosis of a tumor, polymalformation syndromes, sexual abuse, language/learning difficulties. Conclusions: The time of the interview is a concurrent factor for the assessment of the complexity of the care process. Identification of the variables that allow to anticipate these cases is relevant for the organization of the sector or other health care providers (AU)
Subject(s)
Humans , Infant , Child, Preschool , Child , Adolescent , Referral and Consultation/statistics & numerical data , Time Factors , Ambulatory Care/organization & administration , Ambulatory Care/statistics & numerical data , Patient Care Team , Cross-Sectional Studies , Surveys and QuestionnairesABSTRACT
Objective: To decrease the waiting time for preterm babiesvisiting the Retinopathy of prematurity clinic in a tertiary eyehospital.Design: Interventional study.Setting: Tertiary eye care hospital.Patients: All preterm babies reporting for screening and follow upat Retinopathy of prematurity clinic.Intervention/Procedure: A quality improvement teamcomprising of a faculty (team leader), two senior residents, twojunior residents, one nursing officer, and a registration staff wasconstituted.Fish bone analysis was done to understand variousreasons for the high waiting time for preterm babies. Baseline datawas collected followed by multiple Plan-Do-Study- Act (PDSA)cycles.Main outcome measures: Average waiting-time, maximumwaiting-time, and last baby entry-time were measured.Results: The median average waiting-time, maximum waiting-time and last baby entry-time at baseline were 90.5 min (range74.1 to 118.8 min), 177.5 min (range 160 to 190 min) and 111 min(90 to 118 min), respectively. At the end of 3rd PDSA cycle, thesereduced to 77.6 min (range 55.2 to 94.3 min), 122 min (range 110to 135 min), and 60 min (range 45 to 80 min), respectively andwere sustained; the decrease from baseline being 14.3%, 31.2%,and 46%, respectively.Conclusion: The time spent in the waiting area at theRetinopathy of Prematurity clinic was significantly reduced bysimple changes in the process flow.
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Waiting is a common phenomenon in the doctor’s waiting room. The purpose of this audit is to assess patient waiting time and doctor consultation time in a primary healthcare clinic and to formulate strategies for improvement. This audit was conducted at a primary care clinic for 4 weeks using the universal sampling method. All patients who attended the clinic during this period was included in the study except for those who required more time to be seen such as those who were critically ill, aggressive or those who came for repeat medication or procedures only without needing to see the doctor. The time of arrival was captured using the queue management system (QMS) and then the patient was given a timing chit which had to be manually filled by the staff at every station. The waiting time for registration, pre-consultation, consultation, appointment, payment and pharmacy were recorded as well as consultation time. The data were entered into the statistical software SPSS version 17 for analysis. version 17. Results showed that more than half of the patients were registered within 15 minutes (53%) and the average total waiting time from registration to seeing a doctor was 41 minutes. Ninety-nine percentage of patients waited less than 30 minutes to get their medication. The average consultation time was 18.21 minutes. The problems identified in this audit were addressed and strategies formulated to improve the waiting and consultation time were carried out including increasing the number of staff at the registration counter, enforcing the staggered appointment system for follow-up patients and improving the queuing system for walk-in patients.
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BACKGROUND: We evaluated new patient's satisfactory consultation time (SCT) and their willingness to pay additional costs (WPAC) for their SCT. METHODS: We surveyed medical service satisfaction, SCT, WPAC for their SCT, and payable amount to 612 new patients of single general hospital and measured their real consultation time (RCT). To compare WPAC and payable amount, we divided RCT into 4 groups (≤3 minutes, 3–5 minutes, 5–10 minutes, and >10 minutes), and SCT into 3 groups (≤5 minutes, 5–10 minutes, and >10 minutes). On the basis of WPAC, we estimated new patient's SCT. RESULTS: RCT was 6.2 minutes, SCT was 8.9 minutes, and medical service satisfaction score was 4.3 (out of 5). The number of patients having WPAC (payable group) was 381 (62.3%) and the amount was 5,853 Korean won. Their RCT and SCT were longer than non-payable group (6.4 minutes vs. 5.7 minutes, 9.3 minutes vs. 8.2 minutes). From multiple logistic regression analysis, WPAC of RCT 5–10 minutes was higher than that RCT ≤3 minutes (odds ratio=1.78). Payable amount was highest in RCT >10 minutes (6,950 Korea won) and SCT >10 minutes (7,458 Korean won). Intuitively we suggest 10 minutes as SCT, based on payable group's SCT (9.3 minutes) and cut-off time differentiating payable group with non-payable group (10 minutes). CONCLUSION: We found that new patient had WPAC for their SCT and the longer the SCT, the greater the amount. From this, we hope that current simplified new patient consultation fee calculating system should be modified combining the consultation time factor.