我院预约门诊挂号的情况分析与对策简

目的：通过对我院预约门诊的现状分析，探讨制约预约门诊挂号发展的原因，提出较为合理的门诊预约挂号方法。方法采取问卷调查、现地查看和资料查阅等多种方式获取挂号患者的各项信息及挂号数据并分析。结果传统就医思想与预约门诊发展不协调、硬件基础设施与病患日益增多不适应、医生出诊时间与考核机制完善不统一和预约门诊失约率与资源优化配置不匹配等诸多因素造成预约挂号率低。结论整合资源加大宣传力度、多措并举优化预约挂号流程、完善机制激励医生积极出诊和创新手段改善门诊失约现状能够有效提高预约就诊率。     

门诊就医卡对患者就医流程改进的效果评价

挂号是门诊就医的第一个环节，加快挂号流程，减少患者门诊等候时间，是挂号管理系统的目标，也直接影响患者的就医流程和患者满意度。随着我院信息管理系统的运行，门诊挂号流程也随之进行调整，建立门诊患者就医卡，对患者实行刷卡就医，是提高门诊挂号效率的重要措施。初诊患者在建卡中心进行基本信息录入（姓名、性别、出生日期、费用类别、工作单位等个人资料），该卡卡号作为患者在医院内就医的唯一身份，在交费、所需检验过程中使用。     

局域性流程改造的实践和讨论

门诊流程是指患者到医院门诊就诊的整个过程。从患者到达医院开始，包括挂号、候诊、就诊、交费，到检查、化验、治疗、手术、取药等各环节，每个环节都是一个局域性流程。局域性流程的优劣决定每个患者在该环节等待时间的长短，每个环节完成时间的长短，构成患者门诊就医全流程的时间长短。如何更进一步优化环节流程，使就医者在每个环节都能得到快速和满意的处置，是医院管理者需要重点解决的问题。     

依托信息技术 优化就医流程

门诊流程是指患者到医院就诊的全过程，而门诊是医院接触患者时间最早、相对集中且流量最大的部门。传统的门诊流程是使患者适应门诊流程的各个环节，致使在接诊高峰期，挂号、候诊、缴费、取药等就诊过程中往往需要反复排队、等候，大量的时间、精力耗费于非诊治过程，给患者带来诸多不便。军卫一号工程的实施，优化了军队医院门诊就医流程，改变了医师手工书写门诊病历的模式，实现了病历信息共享，使患者资料的提取和存储变得方便快捷，缩短了患者门诊等待时间。     

精益管理在门诊流程改善中的应用

目的 优化门诊流程,充分提高医院门诊医疗资源利用效率.方法 运用精益思想,建立门诊精益管理体系:合理布局门诊就医环境、门诊"银医一卡通"支付模式、多元化预约挂号服务、分诊与排队叫号系统、检查(检验)申请电子集成、门诊药房自助收费系统.有效利用医疗资源,实现门诊人流、物流、信息流的同步并行.结果 完善了门诊就医流程,降低了运营成本,门诊整体运作效率显著提高.结论 精益管理实现门诊流程标准化、管理规范化,有利于提升门诊管理效率.     

优化门诊流程在门诊管理中的地位和作用

目的：分析门诊医疗服务流程中存在的主要问题及原因,设计适应患者就诊需求的服务模式,全面提高门诊医疗服务水平。方法：根据门诊流程现状及问题,提出了信息化辅助流程、简化就诊流程、加强导诊服务、拓宽门诊预约挂号系统范围等方面的解决方案,观察流程优化后的效果。结果：2013年度医院后医疗中心患者网上测评、患者满意度问卷调查满意率达到97%以上。门诊量由改造前的2000人次/d上升到3000人次/d,患者平均候诊时间由优化前的2h缩短到〈1h。结论：优化门诊流程是一项缩短患者候诊时间和医院取得社会效益、经济效益的双重举措,需要持续不断地改进。     

应用门诊信息系统的实践与效果

2009年11月以来,我门诊部引入了门诊信息系统,对优化就医流程、提高服务质量、营造良好就医环境,起到了积极的推动作用。1门诊信息系统的就诊流程1.1挂号分诊系统患者以实名挂号及登记身份证后,可得到一张ID身份唯一的就诊卡,并通过ID号在信息系统后台数据库中建立包括患者姓名、性别、出生日期、住址、联系电话、收费     

某三级医院预约挂号爽约情况及其原因调查

 目的 分析预约挂号患者的爽约情况与原因,采取相关的应对措施,以避免医疗资源的浪费,提升门诊管理和服务水平。方法 提取某医院2016年四季度爽约患者的信息,通过SPSS23.0软件及χ²检验对个人基本信息、预约途径、预约医师类别、预约提前天数等进行分析统计。对2017年某1周爽约患者,使用医院固定电话于患者爽约次日进行爽约原因调查。结果 2016年四季度共预约挂号15 207人次,爽约2654人次,爽约率为17.45%,不同的预约途径、预约医师类别和预约提前天数之间爽约率差异有统计学意义。电话回访爽约患者共283人次,回访成功251人次,爽约原因中,主观原因占39.84%,客观原因占49.80%,其他原因占10.36%。结论 在预约挂号提供便捷服务的同时,医院和患者应共同维护预约诊疗的有序运行。医院应制定有针对性的应对措施,合理调整资源配置,提高门诊预约诊疗服务质量。     

患者到医院就诊的注意事项

门诊就诊注意事项①初次到医院就诊的病人在挂号时一定要买门诊病历，以便医生记录您的病情。门诊病历各科通用，复诊病人只要带门诊病历挂号就诊就行了。②公费及医疗包干病历患者在挂号时请出示您的医疗卡。③就诊次序原则上按挂号的先后次序，有特殊困难的患者请与服务台商量解决。④门诊化验抽血时间多为每天上午8：00～11：00。⑤查找化验单时，持门诊病历的患者一般要到服务台或门诊化验室窗口查找，持住院病历的患者的化验单会被送回其所住科室、贴在其病历上，无需自己取化验单。     

Browser/Server结构的武警三级网预约挂号系统的设计与实现

为优化官兵就诊流程,解决部队患者就诊排队挂号时间长的问题.我们通过需求分析确定业务流程,选择系统开发框架和开发工具,利用JAVA WEB应用的结构清晰、可复用性好、维护方便等特点,设计并实现B/S（Browser/Server）结构的武警部队三级网的官兵预约挂号系统.为部队患者就诊免去了排队挂号环节,节约了就诊时间,拓宽了为部队服务途径,提高了卫勤保障水平.     

医院门急诊灾后重建中的问题及对策

目的 探讨医院门急诊在灾后重建中存在的问题和应对策略.方法 以调研、检查、走访、坐谈和问卷等形式,对2008年6月～2009年6月的就诊患者2万人次、社会各界人士800人次、医护人员1600人次进行调查,集成地震后医院门急诊重建中存在的问题,针对问题实施改进措施,对比整改措施实施前后的效果.结果 灾后重建中门急诊面临大...     

Changing the face of radiology: redesigning patient-focused care

Mercy Hospital began the redesign of its patient-focused care in 1991. A steering committee composed of members from multiple disciplines was asked to create a seamless, patient-focused environment that would coordinate and align hospital resources in the service of patients and families. The director of diagnostic and clinical services served on that committee and used the committee's operating goals and principles to transform Mercy's radiology department into a diagnostic center. As part of its redesign effort, the radiology department reviewed its outpatient environment. Since so many of its patients came to have at least one of three procedures (EKGs, radiology exams and phlebotomy services) and since they must all register, the department decided to concentrate first on its registration procedure. A meeting with the medical records department resulted in the reception and scheduling staffs learning the registration process. After the two staffs went through an aggressive training program of about three months, it was possible to combine the two positions into one. Training staff members to schedule all modalities in the radiology department was next. With further cross-training, staff members now perform centralized scheduling for radiology, endoscopy and osteoporosis. Physicians can schedule such exams with only one phone call. Could technologists learn to draw blood too? Members of the healthcare team accepted the challenge to become more diversified and expand their skills. The author explains how the technologists became certified phlebotomists. With that success underway, the team accepted volunteers for EKG training. The author presents the benefits of the various steps taken, and looks at possible future opportunities in cross-training at the hospital.     

The impact of common variables on non-attendance at a radiology centre in Singapore

IntroductionWith the increasing demand for medical imaging, non-attendance inhibits private and public radiology practices in Singapore from providing timely care and achieving maximal efficiency. Missed radiological appointments adversely affect clinical and economic outcomes and strain the finite healthcare resources. We examined the prevalence and predictors of patient non-attendance for radiological services at a regional public hospital in Singapore and compared them against other medical imaging centres globally.MethodsOutpatient records of patients who were scheduled for specialised medical imaging obtained from Radiological Information System (RIS) were retrospectively reviewed. Analysed variables include patient demographics, radiology modalities, visit statuses and appointment lead times where Pearson's chi-square test and Fisher's exact test were used for categorical variables, and independent sample t-test was used for continuous variables. The association between each patient characteristic and non-attendance status was assessed using Binary Logistics Regression. Variables that showed statistical significance in univariate analysis were included in the multivariate logistic regression model to identify the independent risk factors associated with non-attendance.ResultsAmong the 59,748 outpatient appointments with medical imaging requests, 15.5% did not turn up for their appointments. Logistic regression indicated that patient's age, ethnicity, subsidy status, house ownership, living vicinity to regional hospital cluster, appointment wait times, appointment hours and appointment months were significant factors associated with the failure to attend scheduled radiological examinations.ConclusionEven though predictors of non-attendance remained consistent across medical imaging centres worldwide, Singapore reported a higher prevalence of missed appointments calling for future exploratory studies to understand the population's health-seeking behaviours and ordering patterns of clinicians.Implications for practiceComparison and identification of these predictors will assist in the design of targeted interventions that may improve patient's adherence and utilisation of imaging services.     

Predicting costs of Veterans Affairs health care in Gulf War veterans with medically unexplained physical symptoms

Measures of post-traumatic stress disorder (PTSD) and depression were used to predict Veterans Affairs outpatient treatment costs among Persian Gulf War veterans with medically unexplained physical symptoms. Patients (N = 206) enrolled in a Veterans Affairs primary care clinic for Persian Gulf War veterans completed study assessments at the initial appointment or at a proximal follow-up visit. Costs of care for mental health, medical, and pharmacy services for these veterans were computed for the subsequent 6-month period. Depression and PTSD symptoms explained a significant share of variance in costs of mental health care and pharmacy services, after adjustment for covariates. None of the mental status measures was significantly related to costs of medical care. Models using global measures of mental health status were as robust as models using disorder-specific measures of PTSD and depression in predicting mental health care and pharmacy costs. The implications of these findings for anticipating costs of care for Persian Gulf War veterans are discussed.     

Location,Location, Location: The Association Between Imaging Setting and Follow-Up of Findings of Indeterminate Malignant Potential

PurposeTo evaluate the relationship between patient location at time of imaging and completion of relevant imaging follow-up for findings with indeterminate malignant potential.MethodsWe used a mandatory hospital-wide standardized assessment categorization system to analyze all ultrasound, CT, and MRI examinations performed over a 7-month period. Multivariate logistic regression, adjusted for imaging modality, characteristics of patients, ordering clinicians, and interpreting radiologists, was used to evaluate the relationship between patient location (outpatient, inpatient, or emergency department) at the time of index examination and completion of relevant outpatient imaging follow-up.ResultsRelevant follow-up occurred in 49% of index examinations, with a greater percentage among those performed in the outpatient setting compared with those performed in the inpatient or emergency department settings (62% versus 18% versus 17%, respectively). Compared with examinations obtained in the outpatient setting, examinations performed in the emergency department (adjusted odds ratio [aOR] 0.07; 95% confidence interval [CI], 0.03-0.19) and inpatient (aOR 0.14; 95% CI, 0.09-0.23) settings were less likely to be followed up. Black patients and those residing in lower-income neighborhoods were also less likely to receive relevant follow-up. Few lesions progressed to more suspicious lesions (4.6%).ConclusionsPatient location at time of imaging is associated with the likelihood of completing relevant follow-up imaging for lesions with indeterminate malignant potential. Future work should evaluate health system-level care processes related to care setting, as well as their effects on appropriate follow-up imaging. Doing so would support efforts to improve appropriate follow-up imaging and reduce health care disparities.     

人工流产与药物流产对恢复排卵时间影响的临床研究

目的监测流产后妇女排卵时间,研究人工流产与药物流产对恢复排卵时间的影响。方法选择本院门诊进行流产的妇女共124例,分为人工流产组（61例）和药物流产组（63例）,利用BBT测定、尿促黄体生成素（LH）半定量检测试纸测定和B超（USS）监测排卵恢复时间。结果两组问年龄、孕次、初潮年龄等差异均无统计学意义（P〉0．05）;秩和检验表明,药物流产组排卵恢复时间明显滞后于人工流产组（P〈0．05）。结论药物流产较人工流产患者排卵恢复时间延迟,这可能与药物流产改变患者体内内环境有关系。     

全局异常信号环境下基于体素灰度多模医学图像配准研究

目的 在全局异常信号环境下,找出适合于临床应用的、满足精度和鲁棒性要求的基于体素灰度多模医学图像配准相似性测度。方法 结合对各种相似性测度的分析,对无异常信号的实际医学图像,和分别加了随机噪声及全局异常信号的多模医学图像进行配准精度的分析。结果 对各种已有成熟的相似性测度进行理论分析和实验对比研究的基础上,归一化互信息在全局异常信号环境下对多模医学图像进行配准,它们的配准精度和鲁棒性表现都令人满意,能得到准确的配准结果。而基于相关比和互信息的配准方法,不能准确地配准加了全局异常信号的多模医学图像。结论 相比于其他相似性测度,归一化互信息在全局异常信号环境下,是一个能满足配准精度和鲁棒性要求的合适相似性测度。     

我院门诊药房退药原因分析及改善措施

目的 分析我院门诊患者退药原因,合理干预并妥善解决退药的问题.方法 对我院2010年1月～2012年11月门诊退药处方进行全面而系统的统计与分析.结果 药师合理干预退药并与医师及患者进行良好的沟通,能有效地减少退药,进而减少医患纠纷.结论 为了有效降低门诊的退药率,药师可进行适当的退药干预,加强药品信息系统的维护,做好与医生及患者的交流工作,避免医患纠纷的发生.