Prescription-filling process reengineering of an outpatient pharmacy.

Shortening waiting times is the most obvious and effective method of increasing service quality. As the workforce is limited, it is necessary to reform current systems of medical care and improve the efficiency of medical care. After process reengineering was proposed in 1990s, however, this concept has not yet been commonly applied to medical centers. The subject of this study was an outpatient pharmacy in a medical center. This study applied the methods of a time study to measure field observations and as an analytic tool in process reengineering. The results show that the pharmacists were hindered in filling prescriptions for the following reasons: the preparation of certain prescription units, the menial sorting of medicines and also storage issues related to medicines. Improving the process will decrease time wasted by 10.41% and enhance service by 8.95%. The reengineering process resulted not only in a reduction in outpatients' waiting time but also enhanced the quality and competitiveness of the Hospital's medical treatment.

Predictors of mortality in hospitalized diabetic patients: A 7-year prospective study.

UNLABELLED: This study was conducted to investigate the mortality rate, causes of death, and standardized mortality ratio (SMR), and to identify the significant predictive factors of mortality in diabetic patients at a medical center in Taiwan. Clinical data were obtained from 1792 diabetic inpatients discharged from the metabolism department of a medical center during the years 1996-2002. Underlying causes of death were determined from death certificates. Predictors of mortality were assessed by uni- and multivariate Cox survival analyses. Of 1792 patients studied, 410 (22.9%) patients died. The crude mortality rate was 93.2/1000 person-years, and the overall SMR was 2.98 (2.71-3.28). The percentages of causes of death ascribed to diabetes, cancer, cardiopulmonary disease, infection, stroke, digestive diseases, nephropathy, accidents, suicide, and disease of arteries, arterioles, and capillaries were 38.0, 13.2, 9.5, 7.8, 7.6, 6.8, 5.1, 2.0, 0.5, and 0.2%, respectively. The independent predictors of mortality were age greater than 65, duration of hypertension more than 5 years, 24h proteinuria greater than 0.3g, and estimated creatinine clearance less than 60mL/min. CONCLUSION: The mortality of diabetic inpatients was about threefold that of the general population. The predictors of mortality included older age, longer duration of hypertension, increased 24h proteinuria, and decreased creatinine clearance.