多元化门诊预约系统的构建与实施

目的：探讨多元化门诊预约系统的构建方法与实施效果。方法构建网络预约、电话预约、现场预约、诊间预约、住院患者门诊复诊预约等多元化预约系统,并实施患者预约、患者爽约的管理及医生停改诊管理。结果2013—2015年3年门诊预约率、各种预约途径的比率及停诊和失约率比较差异均有统计学意义（P<0．05）;建立多元化的预约挂号系统后,门诊预约率逐年上升,2015年预约率达到了52.7%;停诊率逐年下降,2015年停诊率仅为5.3%;患者爽约率逐年下降,2015年爽约率仅为5.0%。结论多元化的预约挂号系统的建立,使门诊预约率逐年上升;住院患者门诊复诊预约,不仅方便出院患者门诊随访,而且实现了对患者的连续治疗的管理;爽约号源的管理,使爽约逐年下降;规范停改诊,出诊情况及停改诊率及时反馈给科室,降低了停诊率,预约患者就诊得以保证。     

微信预约挂号服务模式在综合医院中的应用

目的:探讨微信预约挂号服务模式在综合医院中的应用。方法:微信预约挂号服务模式实施发展10个月后,通过从医院信息系统(HIS)中,调取2015年8月的4种预约挂号模式在总预约数、主动取消预约数、爽约人数方面的数据,计算出主动取消预约率、爽约率,并进行比较研究;在微信预约挂号模式实施前及实施10个月后,随机抽取我院400例就诊者作为调查对象,采用自行设计的调查问卷,对就诊者满意度进行调查。结果:实施微信预约挂号服务模式后,主动取消预约率、爽约率与其他预约挂号模式比较,有统计学意义(P0.01),预约率仍偏低;微信预约挂号模式实施后就诊者满意度明显提高,与实施前就诊者满意度对比有统计学意义(P0.01)。结论:微信预约挂号模式是完善预约诊疗体系的一项新举措,是医院信息化建设的必然阶段,具有快速、便捷、有效的特点,能有效地降低爽约率,提高就诊者满意度,值得进一步完善与推广。     

儿童医院门诊实行多平台实名制付费预约挂号的效果探讨

目的:探讨实行多平台实名制付费预约在某三甲儿童医院门诊中的应用效果。方法:选取2015年6~8月及2016年6~8月实施多平台实名制付费预约挂号前后两个时间段我院门诊就诊患者作为研究对象,比较我院门诊开辟多平台实名制付费预约前后的预约挂号率、爽约率。结果:儿童医院门诊实行多平台实名制付费预约后,其门诊预约挂号率上升了,差异有统计学意义(P0.05);其爽约率降低了,差异有统计学意义(P0.05)。结论:儿童医院门诊实行多平台实名制付费预约后,有利于提高医院门诊患者预约挂号率,降低预约患者爽约率,从而优化了医疗资源到高效利用,缩短了患者候诊时间,减少了患者及家属在医院滞留时间,对号贩子起到了一定的抨击作用。     

两种预约挂号方式效果分析

[目的]了解预约挂号现状,分析医院预约和利用预约平台预约模式在开放号源、预约率、爽约率方面的不同,探索出适合不同级别医院扩大预约挂号的最佳模式。[方法]对2009年11月—2011年10月两种预约模式在开放号源、预约率、爽约率进行比较研究。[结果]在医院投入的人力、物力、财力不变的情况下,利用预约平台预约使预约号源扩大了2.5倍,爽约率降低了1倍。两种预约模式放号率比较差异有统计学意义(χ2=1 860.24,P<0.01)。[结论]利用预约平台是医院快速便捷扩展预约挂号的有效模式,预付费制度是减少预约挂号爽约率的有效措施。     

实名制预约挂号系统分诊护士的角色评价

目的:分析实名预约挂号系统实施状况,评价分诊护士在该系统运行中的作用。方法:调查2012年7～10月我院门诊通过预约就诊的25 952人次患者的预约方式、爽约率、就诊性质等因素,阐述该系统中分诊护士的作用及其影响。结果:实名预约挂号患者占实际就诊总人数(n=115 122)的22.54%,以诊间预约最高,达21 861人次,占84.24%;其次为电话预约3190人次,占12.29%;窗口预约769人次,占2.96%;网上预约132人次,占0.51%。爽约4567人次,爽约率为17.60%。分诊护士的预约提醒、爽约纠正、窗口指导、预约协调、预约宣传和专家督促等全新作用直接促进了自动预约挂号系统的有效运行。结论:实名预约挂号系统尚有诸多技术层面有待改进,分诊护士在该系统中发挥着至关重要的补充和完善作用。     

医院预约诊疗服务管理的问题与对策

目的分析我院预约诊疗服务中存在的管理问题,探索提高患者预约率、降低爽约率、提升医疗服务质量的方法,切实解决"看病难"问题。方法依托信息技术,规范预约流程,加强精细化科学管理,不断开展多形式的预约挂号服务。结果通过强化预约挂号系统的优化管理模式,我院预约人数逐年上升,明显提高了门诊复诊预约率,降低了爽约率,缓解了候诊拥堵问题,提高了门诊预约满意度。结论预约诊疗服务是医院开放服务的窗口,不断提高医院预约诊疗服务质量,才能提高患者就医满意度。     

专职预约队伍开展预约挂号的实施效果

目的探索建立专职预约队伍实施预约挂号服务的效果。方法成立护理专职预约队伍,进行人员培训,规范预约流程,进行广泛宣传。结果预约挂号量增加,病人爽约率下降,病人满意度提高,病人挂号、门诊预约类投诉由每月4～5起降至0起。结论专职预约队伍的建立提高了门诊护理服务质量,使挂号就诊有序、节时,满足了病人对门诊护理服务的需求。     

门诊实行预约挂号管理的实践体会

目的:探讨医院门诊预约挂号服务管理开展的意义、渠道和方式。方法:依托医院网络信息技术,逐步完善开展医院门诊预约服务的科学化管理。简化、优化预约挂号及就诊流程,规范医师出诊管理、合理配套人力资源。结果:通过三年实行门诊预约挂号服务管理,预约人数、预约成功率逐年上升,较好地缓解了医院门诊挂号、候诊拥堵问题。另一方面预约挂号时效优势无明显体现。结论:开发外延网络信息中心平台,使门诊预约挂号规范化、科学化、信息化,有利于给患者提供优质高效的服务。     

首次复诊预约挂号对青光眼患者复诊依从性的影响

目的探讨首次复诊预约挂号对提高青光眼患者出院后1周复诊率的效果。方法2009年1月—2010年9月出院患者290例为对照组,实施常规出院指导,发放手术医生出诊时间表;2010年10月—2011年4月出院患者87例为观察组,实施首次复诊预约挂号,为青光眼术后出院患者首次复诊提供预约挂号,同时将预约挂号短信提示发送到患者或家属手机,比较两组患者出院1周复诊率。结果青光眼术后出院患者首次复诊预约挂号能提高患者出院1周复诊率,差异有统计学意义（字2=12.685, P<0.01）。结论青光眼术后出院患者首次复诊分时段预约挂号对提高青光眼术后出院患者复诊依从性是行之有效的护理措施,既方便了患者,又优化了门诊就诊秩序。     

门诊预约挂号服务的持续质量改进及效果

目的探讨医院门诊预约挂号服务的持续改进及效果。方法通过采用搭建统一预约管理服务平台、拓展预约方式和取号途径、开展预约诊疗服务调查统筹安排预约号源、加强出诊医生管理、加大预约诊疗服务宣传推广力度,提高患者知晓率等措施进行改进,并将改进后的效果与改进前进行比较分析。结果预约挂号服务的持续改进使医院预约率逐年提升,患者等候时间缩短,患者满意度提高。结论预约挂号服务是加快患者分流,改善医院就诊秩序的主要措施,不断提升预约挂号服务质量,是提高患者满意度的必要手段。     

三甲专科医院门诊预约挂号现状分析及对策

目的 通过对医院信息系统（HIS）门诊预约挂号的数据分析,探讨预约诊疗制度的经验与不足,以提高门诊挂号的预约面及降低预约挂号的失约率,从而优化门诊服务管理和资源配备.方法 从是否为专家预约,是否在预约时即刻收费,预约的具体方式等角度对预约挂号进行分类统计及横向对比,找出现有制度的效用与不足.结果 随着预约挂号制度的推进,预约挂号类型各自占比在动态变化.2011年宁波市康宁医院电话预约数3 188个（58.31％）,占总预约数比例最高,网上预约数1 752个（32.05％）,诊间预约数527个（9.64％）;随着市卫生网网上挂号系统进一步推广和患者对预约挂号制度知晓度的提高,2012年的情况也相应变化,预约数提升至7 229个（51.28％）,网上预约数5 154个（36.56％）,电话预约总数降为1 714个（12.16％）;但是主要问题仍为预约率低（2011为4.31％;2012年为10.14％）及失约率高（2011年为35.50％,2012年为26.37％）.2011年推出预约挂号制度,当年预约人数5 467个,2012年预约数达14097个.但与总体挂号数对比,患者更习惯于传统就诊模式,2011年预约挂号数占挂号总数126 755个的4.31％;2012年预约挂号数和预约数都有所增长,预约挂号占全年挂号总数138 958个的10.14％.不同职称间患者预约取号率差异无统计学意义（P＞0.05）.即时付费与否的失约率比较差异有统计学意义（P＜0.01）;心理咨询门诊的失约率较精神科门诊的失约率明显偏低,两组比较差异有统计学意义（P＜0.01）.结论 进一步加强门诊服务管理和宣传,完善信息平台,采用预约即时扣费及优化诊间预约来针对性改进.     

地市级医院开展门诊预约诊疗服务的效果

目的在公立医院推行门诊预约诊疗服务,改变传统挂号模式,提高患者满意度。方法通过电话、现场、诊间、候诊区和网络等方式预约,合理分配诊疗时间,对门诊预约实施流程化管理。结果预约量稳步上升,复诊预约率逐渐增加,失约率下降,患者满意度提高(P0.01或P0.05)。结论开展门诊预约诊疗服务可有效减少候诊时间,提高预约就诊率,改善患者就医感受。     

Mobile Crisis Team Intervention to Enhance Linkage of Discharged Suicidal Emergency Department Patients to Outpatient Psychiatric Services: A Randomized Controlled Trial

Objectives: Many suicidal patients treated and released from emergency departments (ED) fail to follow through with subsequent outpatient psychiatric appointments, often presenting back for repeat ED services. Thus, the authors sought to determine whether a mobile crisis team (MCT) intervention would be more effective than standard referral to a hospital‐based clinic as a means of establishing near‐term clinical contact after ED discharge. This objective was based on the premise that increased attendance at the first outpatient mental health appointment would initiate an ongoing treatment course, with subsequent differential improvements in psychiatric symptoms and functioning for patients successfully linked to care. Methods: In a rater‐blinded, randomized controlled trial, 120 participants who were evaluated for suicidal thoughts, plans, or behaviors, and who were subsequently discharged from an urban ED, were randomized to follow‐up either in the community via a MCT or at an outpatient mental health clinic (OPC). Both MCTs and OPCs offered the same structured array of clinical services and referral options. Results: Successful first clinical contact after ED discharge (here described as “linkage” to care) occurred in 39 of 56 (69.6%) participants randomized to the MCT versus 19 of 64 (29.6%) to the OPC (relative risk = 2.35, 95% CI = 1.55–3.56, p < 0.001). However, we detected no significant differences between groups using intention‐to‐treat analyses in symptom or functional outcome measures, at either 2 weeks or 3 months after enrollment. We also found no significant differences in outcomes between participants who did attend their first prescribed appointment via MCT or OPC versus those who did not. However divided (MCT vs. OPC, present at first appointment vs. no show), groups showed significant improvements but maintained clinically significant levels of dysfunction and continued to rely on ED services at a similar rate in the 6 months after study enrollment. Conclusions: Community‐based mobile outreach was a highly effective method of contacting suicidal patients who were discharged from the ED. However, establishing initial postdischarge contact in the community versus the clinic did not prove more effective at enhancing symptomatic or functional outcomes, nor did successful linkage with outpatient psychiatric care. Overall, participants showed some improvement shortly after ED discharge regardless of outpatient clinical contact, but nonetheless remained significantly symptomatic and at risk for repeated ED presentations. ACADEMIC EMERGENCY MEDICINE 2010; 17:36–43 © 2009 by the Society for Academic Emergency Medicine     

儿科门诊服务模式创新和精细化管理

目的探讨精细化管理在儿科门诊服务模式中创新性作用。方法引入精细化管理理念和技术,针对儿科门诊候诊时间长、就诊环境差、医患沟通不佳等现存问题,采取规范化服务行为、合理调配人力资源、引入流程管理、缩短等候时间、加强医患沟通、改善就医环境等细节管理。结果采取精细化管理后有效缩短了预约患儿的等候时间和平均等候时间,提高了预约率,提高了患儿家属的满意度,提高了儿科门诊的运行效率。结论在儿科门诊服务中推行的精细化管理模式是行之有效的管理创新方法,值得推广。     

母婴延续性健康管理平台的构建及应用

目的 构建基于“互联网+”的母婴延续性健康管理平台,为给予母婴出院后的延续性护理服务提供参考。方法 构建的母婴延续性健康管理平台由产妇端和医护端2个部分构成。(1)产妇端包括个人信息页面及服务项目界面,支持个人信息注册、既往健康档案查询、团队选择及预约、服务评价等;(2)医护端包括个人工作站、预约服务申请显示及接诊沟通界面,支持医护人员注册、查看预约服务、接诊。利用平台实施母婴延续性健康管理。收集2021年1月25日—8月31日平台的开展情况及产妇对平台使用体验等相关数据。结果 平台自上线以来,累积服务990名产妇,重复使用率为38.28%(379/990);咨询内容涵盖产褥期母婴护理的多个方面,其中由医护技共同参与解决的团队问诊共计42例次（4.24%）;251名（25.36%）产妇咨询指导的时间在非工作时段。结论 母婴延续性健康管理平台具有便捷、高效、专业的特点,运行良好,提高了产妇的参与度,满足了多元化的健康需求。     

护士分时段现场预约与走动式管理在门诊质控管理中的应用

目的探讨在门诊质控管理中采用护士分时段现场预约与走动式管理的效果。方法选择2020年3—4月在医院门诊就诊的患者89例作为对照组,实施常规门诊质控管理;同时选择2020年5—9月在医院门诊就诊的患者84例作为观察组,实施护士分时段现场预约与走动式管理;对比两组诊疗服务效果、就诊质量、护理管理质量及患者的满意度。结果观察组挂号时间、候诊时间、诊疗完成时间均短于对照组(P<0.05);观察组服务情况、就诊环境及诊疗体验均优于对照组(P<0.05);观察组分诊护理、药物管理、导诊服务、宣教水平、院感控制及行为规范均优于对照组(P<0.05);观察组患者对护理质量的满意度高于对照组(P<0.05)。结论在门诊质控管理中应用护士分时段现场预约与走动式管理效果显著,有效提高门诊的护理质量,缩短就诊、挂号时间,保证就诊顺利。     

Closing the Gap: The Role of Discharge Nurses in an Emergency Department

IntroductionPatients discharged from the emergency department may require a follow-up appointment with an outpatient specialty clinic. Referral processes vary by clinic, some requiring faxed referrals, some providing appointments immediately, and others contacting the patients directly. The frequency with which patients are successfully connected with outpatient follow-up services is largely unknown.MethodsThe ED discharge nurse role was developed to facilitate the navigation of patient follow-up and confirm that patients successfully connect with specialty outpatient clinics. Eight emergency nurses were recruited into this position to study the problem using a quality improvement approach. The ED discharge nurses reviewed referrals, contacted clinics and patients discharged from the emergency department, and intervened when barriers to transition occurred.ResultsThe ED discharge nurses were able to determine specific causes and themes of missed appointments experienced by patients. Systemic problems identified include lost faxes, illegible contact information, incomplete referrals, and referral refusals by the clinics without patient notification. Considering the variability of clinic processes outside the emergency department’s control, the ED discharge nurse role became crucial in minimizing the risk of lost/unsuccessful follow-up for patients discharged from the emergency department.DiscussionImplementing the ED discharge nurse role created a contact for outpatient clinic referrals, patient inquiry, and a process to track errors and data to better understand the frequency of missed follow-up. In this quality improvement initiative, the role of the ED discharge nurse addressed the risk of patients falling through the cracks of a complex system.     

Mobile telephone short message service reminders can reduce nonattendance in physical therapy outpatient clinics: a randomized controlled trial

Taylor NF, Bottrell J, Lawler K, Benjamin D. Mobile telephone short message service reminders can reduce nonattendance in physical therapy outpatient clinics: a randomized controlled trial.ObjectiveTo investigate whether short message service (SMS) reminders reduce nonattendance in physical therapy outpatient clinics.DesignProspective single-blinded randomized controlled trial.SettingTwo physical therapy outpatient departments in metropolitan acute public hospitals.ParticipantsParticipants with an appointment in a physical therapy outpatient clinic and who provided a contact mobile telephone number were included. Participants were excluded if their appointment was scheduled for the same day on which they made the appointment.InterventionParticipants allocated to the intervention group received an SMS reminder before their next appointment; participants allocated to the control group did not receive a reminder.Main Outcome MeasuresThe primary outcome was rate of nonattendance without cancellation. Secondary outcomes were cancellation and attendance rates and exploration of other factors associated with nonattendance.ResultsPatients (N=679) were allocated to receive either an SMS reminder (n=342) or no reminder (n=337). The nonattendance rate for patients who did not receive a reminder (16%) was more than nonattendance for patients receiving the SMS reminder (11%; odds ratio, 1.61; 95% confidence interval [CI], 1.03–2.51; number needed to treat, 19; 95% CI, 9–275). There were no differences in cancellation or attendance rates between groups. Exploration of other factors found that patients who were younger with a neck and trunk musculoskeletal or a neuromuscular disorder and who were scheduled to have an initial appointment or an appointment on a Monday or Friday were significantly predictive of increased nonattendance.ConclusionsSMS reminders can reduce nonattendance in physical therapy outpatient clinics.     

不同挂号模式在口腔内科门诊应用的效果

目的 探讨口腔内科门诊不同挂号模式的优劣.方法 抽取2011年5月以来我院3种挂号模式的患者208例,其中现场挂号患者84例,预约复诊患者84例,预约初诊患者40例.比较现行3种挂号模式的候诊时间.结果 现场挂号、预约复诊、预约初诊3种挂号模式的候诊时间分别为(48.36 ±50.18),(10.12±8.68),(24.00±19.04)min,差异有统计学意义(F =27.83,P＜0.01).3种挂号模式两两比较,预约复诊和预约初诊挂号患者的候诊时间短于现场挂号的患者(t值分别为7.41,3.78;P均＜0.01),预约复诊患者的候诊时间短于预约初诊的患者(t=2.16,P＜0.05).结论 预约挂号与现场挂号模式相比,患者的候诊时间明显缩短.预约挂号是解决门诊患者“挂号时间长、交费时间长、候诊时间长、诊疗时间短”问题的有效措施.