预约诊疗服务新模式——分时段就诊

利用信息化手段开展门诊预约诊疗服务,可优化门诊诊疗服务流程,节省患者排除挂号、交费及候诊时间,方便患者就医。苏州大学附属第一医院结合医院门诊的实际,启用分时段预约模式,采用多通道终端载体的预约挂号技术,实现医院门诊流程的优化,提高了工作效率。     

再造门诊挂号流程 推进预约诊疗服务

预约诊疗服务是公立医院开展＂以病人为中心＂优质医疗服务的重要举措之一,开展预约诊疗服务对于方便患者就医、提高工作效率和改善医疗服务水平具有重大意义。近十年来,我院以信息化手段为依托,通过推广实施多种预约挂号服务方式、强化门诊预约挂号服务的组织与管理等一系列措施,对门诊就医流程进行再造。优化后的门诊服务流程,大大缩短了患者非诊疗等候时间,提高了患者的满意度,取得了较好的社会反响,为医院创建国家级优质医院奠定了坚实基础。     

预约挂号实施中的问题与对策

为改进医院门诊服务流程,提高预约诊疗服务质量,对医院预约挂号实施过程中存在的问题进行分析并采取相应的对策.认为通过加大宣传力度、加强号源及就诊管理、完善预约平台、降低失约率、重视停替诊管理及预约护士的作用,是提高预约诊疗服务质量的关键.     

夏门：关注就医体验，改善医疗服务

实施预约诊疗服务及流程优化,方便患者就诊。全市公立二级甲等以上医院均已建立预约诊疗平台,以厦门市市民健康信息系统和固定预约电话、自助挂号机、“114”、“12580”、网络等为平台开展24小时预约服务,并将预约服务内容从单纯门诊预约延伸到提供出入院和大型设备检查（特殊检查）的预约;     

预约挂号需要完善配套服务措施

围绕预约挂号服务的开展,我院结合自身实际情况,建立相应的预约挂号配套服务。通过多渠道的医疗咨询,医院现场咨询和外延式电话专线咨询、电信部门的医疗咨询相结合,完善医院的标识和就诊指引,加强门诊开诊管理等措施,切实提升了医院预约挂号服务的水平,改善了服务质量,从而优化了门诊流程。对有效推进预约挂号服务的开展具有实际意义,并为预约诊疗工作的可持续发展夯实基础。     

目标化管理在提高门诊预约诊疗服务质量及患者满意度中的应用

探讨目标化管理对门诊预约诊疗服务质量及患者满意度的影响,为提高门诊服务水平提供参考。方法 选取2020年1月—2020年6月在郸城县慢性病医院接受常规门诊预约服务的106例患者作为对照组,选取2020年7月—2021年1月接受目标化管理门诊预约服务的110例患者作为观察组。比较2组患者预约挂号率及意愿就诊率,患者挂号就诊渠道、患者诊疗等候时长、预约诊疗服务质量、患者满意度等指标。结果 观察组患者预约挂号率、意愿就诊率均高于对照组,差异均有统计学意义（P＜0.05）。观察组患者微信公众号、电话预约挂号率高于对照组,自助挂号机、人工窗口挂号率低于对照组,差异均有统计学意义（P＜0.05）。观察组患者预约挂号所需时长、线上预约候诊时长均短于对照组,差异均有统计学意义（P＜0.05）;2组患者现场挂号候诊时长比较,差异无统计学意义（P＞0.05）。观察组患者就诊环境、工作态度、诊疗效率、人文关怀、就诊秩序5项服务质量评分均高于对照组,差异均有统计学意义（P＜0.05）。观察组患者预约流程、门诊服务、就诊时间、候诊时长、医护态度5项护理满意度评分均高于对照组,差异均有统计学意义（P＜0.05）。结论 目标化管理能改善门诊预约诊疗服务质量及患者满意度,在提高患者诊疗效率的同时提高线上预约就诊率。     

分时段预约挂号的实现与应用

我院依托医院信息化平台,在创新预约挂号模式,预约号源管理,改善预约挂号服务等方面进行了积极的尝试,尤其在预约挂号方式上,实行分时段预约就诊,推行专家门诊和普通门诊全预约诊疗,由患者自主选择就诊时间,最大程度满足广大群众就医需求,缓解门诊供需矛盾,使门诊医疗活动更加文明有序,缓解患者看病难的突出问题.     

北京市42所医院门诊预约挂号现状调查

目的 通过调查医院门诊预约挂号服务的内容、形式、管理模式等情况,为提高医院门诊预约挂号服务质量提供建议.方法 通过对2011-2013年北京市共计42所医院门诊预约挂号服务进行全面统计分析,了解其门诊预约挂号服务现状.结果 目前北京市预约挂号工作呈现覆盖范围广泛、形式多样的特点;患者预约挂号使用率提高,就医习惯逐渐改变.结论 医院应多部门协作,提供完善的配套制度、足够的人力资源等作为保障,推动预约挂号工作进一步发展.     

基于信息化平台的预约挂号服务实践与思考

通过对医院预约挂号服务模式发展历程的分析,探讨各种预约挂号服务模式的优缺点,对现阶段预约挂号实践中碰到的问题进行总结,并提出解决方案,完善预约挂号服务平台,优化门诊流程,改善患者就医体验.     

医院门诊预付费结算方式的探讨

门诊就医流程的特点是诊疗时间相对集中,一次诊疗过程多次付费。为减少病人在门诊的无效流动,缓解门诊“三长一短”现状,各医院除了优化门诊流程、合理设置导医分诊、实行门诊预约挂号等举措外,门诊预付费结算方式的推行是行之有效的举措之一。     

Self-reported health problems among Swedish miners one year after unemployment

Unemployment is considered to be a public health concern sincedeterioration in the health of the unemployed is often anticipated.However, for some groups, such as miners, unemployment mightimprove health due to a cessation of potentially harmful occupationalexposures. This study evaluates the health of 79 miners in oneSwedish iron-ore mine, and 226 age-matched controls from thegeneral population, during one year after the closure of themine. The participants received a questionnaire regarding medicalhistory and subjective symptoms at the beginning of the studyperiod, and after one year. Statistically significant negativeeffects on self-reported health attributable to unemploymentwere not found, although neuropsychiatric symptoms were morecommon among the unemployed miners. The miners reported a statisticallysignificant improvement in grip force (p=0.031). They had asignificantly higher prevalence of symptoms associated withmining related exposures when compared with the population controls;pain in the upper extremities [relative risk (RR)=2.27, 95%confidence interval (Cl)=1.44–3.59), back pain (RR=1.84;Cl=1.237–2.75), vasospastic disease of the fingers (RR=2.05;Cl=1.18–3.57) and obstructive respiratory symptoms (attacksof dyspnea and wheezing: RR=3.67; Cl=1.167–11.6).     

Excès de cas humains et animaux de tularémie en France au cours de l’hiver 2007–2008 : émergence ou phénomène isolé ?

Context

Tularemia is a zoonosis affecting humans and hares in France. We describe the results of surveillance in both species, in 2007 and 2008.

Methods

Human tularemia cases are mandatorily notifiable in France since 2003. In hares, surveillance relies on volunteer hunter associations in all districts of the country. Data from mandatory reports and volunteer surveillance in 2007/2008 were analyzed and compared with previous results.

Results

In 2007/2008, 144 cases were reported in humans and 117 cases in hares. This was a 100% increase compared to previous years. Human cases differed from those of previous years only by the frequency of contact with breeding animals. Human cases without any documented risk exposure were also more frequent.

Conclusion

An increase of tularemia cases occurred in 2007/2008 in both species. Complementary studies are needed to identify the species reservoir in France to understand the causes of this peak of cases.     

Occupational health hazards in mining: an overview

This review article outlines the physical, chemical, biological, ergonomic and psychosocial occupational health hazards of mining and associated metallurgical processes. Mining remains an important industrial sector in many parts of the world and although substantial progress has been made in the control of occupational health hazards, there remains room for further risk reduction. This applies particularly to traumatic injury hazards, ergonomic hazards and noise. Vigilance is also required to ensure exposures to coal dust and crystalline silica remain effectively controlled.     

Manufacture and use of nanomaterials: current status in the UK and global trends

This paper provides an overview of the production and use of nanomaterials (NMs), particularly in the UK. Currently, relatively few companies in the UK are identifiable as NM manufacturers, the main emphasis being the bulk markets in metals and metal oxides, and some niche markets such as carbon nanotubes and quantum dots. NM manufacturing in the UK does not reflect the global emphasis on fullerenes, nanotubes and fibres. Some assumptions have been made about the types of NM that are likely to be imported into the UK, which currently include fullerenes, modified fullerenes and other carbon-based NMs including nanotubes. Many university departments, spin-offs and private companies have developed processes for the manufacture of NMs but may only be producing small quantities for research and development (R&D) purposes. However, some have the potential to scale up to produce large quantities. The nanotechnology industry in the UK has strong R&D backup from universities and related institutions. This review has covered R&D trends at such institutions, and appropriate information has been added to a searchable database. While several companies are including NMs in their products, only a few (e.g. manufacturers of paints, coatings, cosmetics, catalysts, polymer composites) are using nanoparticles (NPs) in any significant quantities. However, this situation is likely to change rapidly. There is a need to collect more information about exposure to NPs in both manufacturing and user scenarios. As the market grows, and as manufacturers switch from the micro- to the nanoscale, the potential for exposure will increase. More research is required to quantify any risks to workers and consumers.     

Investigating clusters in the workplace and beyond

Clusters of disease are common and occur in the workplace and in the general community. They often arouse considerable concern among the population. Investigations have sometimes lead to exciting new knowledge, but in general the investigation of clusters is difficult and often unrewarding, especially for community clusters. In the workplace, investigations are more likely to find associations and even new causes, but still many clusters remain enigmatic. Despite this, there are many reasons for investigating clusters, including allaying community concern and identifying uncontrolled exposures. A structure for investigating clusters in the workplace is suggested.     

Assessing occupational and environmental exposure

Exposure assessment is a poorly understood component of the science of epidemiology. The relationship between exposure to chemicals and ill-health outcomes is often calculated using crude exposure measures such as ever/never exposed or duration. When investigating subtle effects, exposures need to be characterized much more fully in terms of intensity, frequency, duration and route. While occupational exposures tend to be much greater than those experienced from the wider environment there is a need to remember that, for many chemicals, exposure can occur occupationally, environmentally and through consumer use of products containing the material of interest. Inhalation exposure has generally been the traditional focus for most epidemiological investigations but there is now growing awareness of the importance of the dermal and ingested routes of contact and internalization. Quantification of the exposure also needs to be related to a biological mechanism of action and exposure metrics need to be selected accordingly. Occupational exposures can generally be measured using simple well-validated techniques. Environmental exposures require much more sensitive instruments and are more difficult to assess. Exposure modelling, particularly for the environmental fate of chemicals has undergone many recent developments and Monte Carlo techniques can be used to characterize model uncertainty and variability. This approach to exposure assessment can now be used in the setting of the wider environment and will enable a far better understanding of the relationship between exposure and disease.     

Mercury toxicity due to the smelting of placer gold recovered by mercury amalgam

A 19-year-old man developed tremor in both hands and fatigue after starting work at a placer gold mine where he was exposed to mercury-gold amalgam. Examination revealed an intention tremor, dysdiadochokinesis and mild rigidity. The 24-h urinary mercury concentration reached a peak of 715 nmol/l (143 ug/l) shortly before the clinical examination, after which he was removed from working in the gold room [Mercury No. Adverse Effect Level: 250 nmol/l (50 ug/l)]. On review 7 weeks later his tremor had almost resolved and the dysdiadochokinesis and rigidity had gone. The 24-h urinary mercury concentration had fallen to 160 nmol/l (32 ug/l). The principal exposure to mercury was considered to be the smelting of retorted gold with previously unrecognized residual mercury in it. The peak air concentration of mercury vapour during gold smelting was 0.533 mg/m3 (Mercury Vapour ACGIH TLV: 0.05 mg/m3 TWA). Several engineering and procedural controls were instituted. This episode occurred at another mine site, unrelated to Mount Isa Mines Limited.     

How Adults with Acquired Brain Damage Perceive Computer Training as a Rehabilitation Tool: A Focus-group Study

The aim of this study was to explore and describe how adult outpatients with acquired brain damage and referred to occupational therapy perceive computer training with the RehaCom programs, in order to evaluate the method of treatment as a tool in the rehabilitation of persons with cognitive disorders. By using focus-group discussions as a qualitative method of research when analysing the result, five themes with corresponding categories emerged, describing a development of understanding and learning about capacities. Themes describing how the participants could apply strategies to overcome shortcomings in daily occupations and the therapeutic role of the occupational therapist were identified as well. The result shows that a computer training program such as RehaCom can be used as an educational tool, for example, to guide a person who is trying to adopt compensatory strategies to avoid overload by taking pauses. It was found that anything the participants learned was also applicable to occupational performance in daily life.