Consequences of queuing for care at a public hospital emergency department

OBJECTIVE: To determine whether the length of a queue at a public hospital emergency department was associated with increased likelihood of patients' leaving without being seen by a physician and whether leaving adversely affected patients' health or affected their subsequent use of health care services. DESIGN: Observational cohort. Patients were surveyed during 1 week in July 1990 and received a follow-up survey 7 to 14 days later. The responses of patients who left without being seen by a physician were compared with those who were seen by a physician. SETTING: Emergency department at San Francisco (Calif) General Hospital. PATIENTS: All English-, Spanish-, and Cantonese-speaking adults waiting for emergency care were eligible. Of 882 eligible individuals, 700 agreed to participate; 85% of enrolled subjects saw a physician and 15% left without being seen. Demographic characteristics of patients who were and who were not seen were not significantly different. MAIN OUTCOME MEASURES: Emergency department waiting time and changes in patients' self-reported health. RESULTS: Patients were more likely to leave as waiting times increased. At follow-up, patients who left without being seen were twice as likely as those who were seen to report that their pain or the seriousness of their problem was worse. Only 4% of patients who left required subsequent hospitalization, but 27% returned to an emergency department. CONCLUSION: Many patients can appropriately decide whether their problem is truly urgent and make alternative plans in the face of long waits, but the health of some patients may be jeopardized by long queues for emergency care.     

住院药房管理的体会

凡是有住院部的医院,都应设立病区住院药房,住院药房工作担负患者用药安全的重要环节,在确保药品质量及供应发挥作用。住院药房作为医院重要的组成部分,工作的好坏直接影响到医院的形象和经济效益,所以加强住院药房管理在医院管理中占举足轻重的地位。本文阐述了作者在2005年7月~2010年7月五年间在住院药房管理过程中所遇到的一些问题以及遇到问题实行的措施,加以总结,探讨如何更加有效规范住院药房管理、提高药学人员素质、保障患者用药安全并为患者提供高品质的药学服务,按三级医院住院药房的标准执行,为我院"三乙"的评审打下良好的基础。     

大型医院门诊候诊环节管理的实践探讨

分析大型医院门诊候诊现状,提示门诊候诊环节管理在优化门诊服务流程中起到重要作用。首都医科大学宣武医院本着公平透明、人员流向均衡、尊重关爱和安全至上的候诊管理原则,采取分诊叫号系统、排队叫号系统、导诊和咨询服务、多种形式温馨提示、分时段就诊和检查、提高门诊工作效率、便民服务、诊间健康宣教、志愿者服务、院内就诊急救系统等措施,及时分流,缩短等候时间,改善候诊感受,提高门诊整体服务水平。     

药学部门和药师是医院医疗工作四大核心技术支撑系统之一简

医、药、护、技是医疗机构密不可分的医疗工作核心技术支撑系统,缺少任何一方都会严重阻碍医疗工作的正常运行。客观形势要求医疗机构提高药物治疗水平,促进药物的合理使用,医院药学界需要明确临床药学部门和药师的职责,清晰临床药学学科建设的目标、方向、内涵和范畴,正确把握临床药师制体系建设的发展方向,医院药学才能顺利的发展。     

基于HIS的临床药学信息服务系统的构建

目的基于医院局域网络,利用信息化手段构建临床药学信息服务系统,实现医院信息管理系统在临床药学的功能拓展,为开展临床药学服务提供良好的工作平台。方法根据卫生部《全国合理用药监测方案》、《处方管理办法》及临床药学工作模式,使用c#Not程序为开发工具,研究开发临床药学信息服务系统。结果系统实现了对医院基本药品的查询、门诊处方监测、临床药物利用监测、抗菌药物细菌耐药监测,以及在线了解患者用药情况、最新药学动态的发布和局域网内用药咨询功能。结论利用信息化手段开展处方评价、药物利用监测等临床药学工作,可及时了解药品基本信息,对处方和抗菌药物合理应用以及细菌耐药实施预警,并以此为依据对不合理用药行为及时干预,为管理职能部门对医院药品的科学管理和合理应用提供宏观决策依据。     

自动化药房在中医院门诊的应用

目的观察自动化药房在中医院门诊药房的应用效果。方法以中国中医科学院西苑医院2013年11月门诊药房全部处方为研究对象,依据ABC分类法（帕累托分析法）进行品种设计,根据中医院处方特点和实际条件进行药房流程设计,观察其效果。结果 ABC分类方法将药品合理分类,结合中医院用药特点,确定实时发药和预配发药两种发药模式和发药流程,实现药品品种上机率60.9%,门诊处方全自动调配率52.2%,患者平均候药时间274.2 s。结论自动化药房在中医院门诊药房应用广泛,可缩短患者的候药时间。     

Analysis of Factors Causing Long Patient Waiting Time and Clinic Overtime in Outpatient Clinics

This paper is focused on the factors causing long patient waiting time/clinic overtime in outpatient clinics and how to mitigate them using discrete event simulation. A two-week period of data collection is conducted in an outpatient clinic of a Singapore government hospital. Detailed time study from patient arrival to patient departure is conducted, and the possible factors causing long patient waiting time/clinic overtime are discussed. A discrete simulation model is constructed to illustrate how to improve the clinic performance by mitigating the detected factors. Simulation and implementation results show that significant improvement is achieved if the factors are well addressed.     

QCC活动在优化自动摆药机发药中的应用

目的降低摆药机未正常发药次数,减少患者等候时间,提高患者满意度。方法通过QCC活动,对我院医疗保健中心药房摆药机未正常发药的原因进行收集,分析现况、设立工作目标、制定改进方案并实施,评价活动前后的有形结果和无形结果。结果摆药机未正常发药原因包括设备故障和人工错误两大主要因素。通过强化相关人员工作流程的认识,制定明确的提示标语等多项措施,使摆药机未正常发药次数由平均50次/月降低至12次/月,圈员各项能力均有不同程度提升。结论通过实行QCC活动,有效降低了摆药机未正常发药次数,减少药房损失,提高药事服务水平和患者满意度。     

Impact of adjustment measures on reducing outpatient waiting time in a community hospital: application of a computer simulation

Background As an important determinant of patient satisfaction, waiting time, has gained increasing attention in the field of health care services. The present study aimed to illustrate the distribution characteristics of waiting time in a community hospital and explore the impact of potential measures to reduce outpatient waiting time based on a computer simulation approach. Methods Dudng a one-month study period in 2006, a cross-sectional study was conducted in a community hospital located in Shanghai, China. Baseline data of outpatient waiting time were calculated according to the records of registration time and payment time. A simulation technique was adopted to investigate the impact of perspective reform methods on reducing waiting time. Results Data from a total of 10 092 patients and 26 816 medical consultations were collected in the study and 19 947 medical consultations were included. The average of the total visit time for outpatients in this hospital was 43.6 minutes in the morning, 19.1 minutes in the afternoon, and 34.3 minutes for the whole day studied period. The simulation results suggested that waiting time for outpatients could be greatly reduced through the introduction of appointment system and flexible demand-orientated doctor scheduling according to the numbers of patients waiting at different time of the workday. Conclusion Adoption of an appointment system and flexible management of doctor scheduling may be effective way to achieve decreased waiting time.     

临床药学管理系统在我院的应用及体会

目的：介绍临床药学管理系统在我院的上线、运行及经验.方法：从医院对临床药学管理系统的需求分析入手,经过调查研究,前期准备,数据的导入,数据的分析运用.结论：临床药学管理系统能较好的提高医院药品管理质量,降低临床不合理病例数,同时为药品管理者提供客观可靠的数据支持.对药历进行分析研究.     

用KPI方法构建医院药剂科绩效考核体系

传统的以经济利益为导向的医院绩效管理容易使药剂科过度追求利益最大化,造成医院药剂科某些重要职能的丧失。笔者从药剂科关键工作量和主要职能入手,用KPI方法构建医院药剂科绩效考核体系。     

医院门诊电子排队管理系统的设计和应用

目的解决患者看病过程中的各种排队拥挤和混乱现象，做到人人平等、秩序井然，体现医院“以患者为中心”的服务宗旨。方法建立门诊电子排队系统，并应用于全院的挂号、就诊、收费、发药、检验、检查等，使整个医院有机结合起来。结果（1）改善了就医环境；（2）提高了医护人员的工作效率；（3）规范了就诊秩序；（4）为考核医生和管理决策提供依据。结论提高了医院的服务质量，改进了医院的服务形象，减少了患者的就诊等待时间。     

Implement the RFID Position Based System of Automatic Tablets Packaging Machine for Patient Safety

Patient safety has been regarded as the most important quality policy of hospital management. The medicine dispensing definitely plays an influential role in the Joint Commission International Accreditation Standards. The problem we are going to discuss in this paper is that the function of detecting mistakes does not exist in the Automatic Tablets packaging machine (ATPM) in the hospital pharmacy department when the pharmacists implement the replenishment of cassettes. In this situation, there are higher possibilities of placing the wrong cassettes back to the wrong positions, so that the human errors will lead to a crucial impact on total inpatients undoubtedly. Therefore, this study aims to design the RFID (Radio frequency identification) position based system (PBS) for the ATPM with passive high frequency (HF) model. At first, we placed the HF tags on each cassette and installed the HF readers on the cabinets for each position. Then, the system works on the reading loop to verify ID numbers and positions on each cassette. Next, the system would detect whether the orbit opens or not and controls the readers' working power consumption for drug storage temperature. Finally, we use the RFID PBS of the ATPM to achieve the goal of avoiding the medication errors at any time for patient safety.     

药物经济学评价在医院药事管理中的现状与实际应用

探讨药物经济学在现代医院药事管理中现状与实际应用,实现药物经济学与医院药事管理的有机结合,应用决策树方法制定标准化诊疗规范,编制医院基本用药目录及标准处方集,对临床医生实行教育性行为监督,目的在于有效控制药物成本?降低医疗费用,使医院用药规范?合理?经济,减轻患者及社会负担?     

基层医院内科护理服务质量的调查和分析

目的：评价分析患者对我院2009年度内科护理服务质量的认可度。方法：选择2009年1-12月在吉安市中心人民医院院内科就诊的患者共计1200人,其中每月100例,就内科护理服务质量和内科护理最需改进方面进行问卷调查与分析,并提出建议。结果：内科护理服务质量仍然存在显著不足,候诊时间、健康教育咨询和护士服务态度在基层医院内科缺陷严重,亟需注意。结论：基层医院内科在提高护理服务质量方面任重而道远。     

一卡通门诊系统的实施与思考

医院在就诊空间资源有限的情况下,随着日益增长的日门/急诊量,出现了空间与管理上的瓶颈。结合医院的信息化现状,依托医院信息系统的改造,利用一卡通门诊系统进行就诊流程再造,应用排队叫号系统、预约挂号系统、收费核算系统等,减少了患者候诊程序,缩短了候诊时间。一卡通的使用加强了医院管理,提高了门急诊工作效率,改善了医患关系。在使用一卡通的过程中,要不断根据使用情况加以完善,逐渐提高患者、医务工作者、社会的认可度。信息中心工作人员也要不断对系统进行维护,对一卡通中的个人账户余额进行严格管理。     

门诊药房工作模式的改革与创新

门诊药房的工作是医院药学的重要组成部分,也是医院直接面对患者服务的重要窗口。门诊药房工作模式的改革与创新是提高服务质量,保证患者用药安全的重要保障,也是提高医院整体服务水平的重要标志。本文分析了传统门诊药房工作模式存在的问题及原因,阐释了门诊药房工作模式与改革的必要,认为门诊药房工作模式应从药房环境设施、药学服务人员、药学咨询服务、药房管理制度建设以及计算机网络等几方面加以改善。     

我院病区药房退药情况调查及减少退药对策

目的 分析病区药房退药情况,并提出几点相应的对策。方法 对我院2019年1～6月份病区药房6474张退药单中的退药金额、退药科室、退药频次、退药原因进行统计分析。结果 2019年1～6月份退药总金额为1 528 102.01元,约占药品出库金额的1.40%;全院30个科室均有退药,退药总频次达6474次,退药频次前5位的科室依次为21区呼吸科(14.84%)、18区心血管内科一区(12.30%)、7区神经外科(11.23%)、20区心血管内科二区(10.83%)、13区心血管内科三区(6.58%);退药原因主要为患者出院(31.71%)、医嘱调整(27.57%)、药物不良反应(11.12%)、患者转科(8.03%)、护士医嘱录入错误(5.25%)、患者拒绝使用(4.80%)、药房无药(4.14%)、医生重复开具同类药品(3.82%)、患者死亡(3.55%)。结论 我院病区药房退药现象涉及临床各科室,退药金额较大,退药原因较多,医院应当高度警惕退药带来的药品安全隐患,加强对退药的管理,严格执行退药管理制度,加强全体医务人员的业务素质,减少不必要的退药事件发生,保障患者的用药安全。     

我院住院西药房退药现状及原因分析

目的了解我院住院西药房退药原因并采取有效防范措施,促进医院合理用药,提高药房管理水平。方法收集我院2011年8月住院部西楼药房退药处方580张,以《医疗机构药事管理规定》为依据,从退药科室、退药原因、退药品种数角度进行统计分析并提出建议。结果退药处方最多的科室为小儿内科,共124张,占21.4%,其次为神经内三科,共107张,占18.4%;退药金额最多的是放疗科,共26 769.564元,占28.9%;退药原因中的关键因素是医师原因。结论医院应加强管理,制订严格的退药制度,引入奖惩制度,从医师、药师、患者三方面入手,加强其沟通,严格退药手续,防止因退药造成的医疗差错,同时应强化医生合理用药意识,提高合理用药水平,完善医德教育,从而有效控制退药。