提高预约挂号精度改善门诊就医秩序

目的 为预约挂号平台提供患者错峰就诊的准确预约时间,以改善门诊就医秩序.方法 分析预约挂号的特点及存在的问题,利用医院信息系统（HIS）中各专科的门诊时间信息,测算医师对每名患者的平均接诊时间.结果 准确预约时间,使患者有计划就诊,节省时间和医疗外费用,有利于实现错峰就诊,改善门诊就医环境.结论 预约挂号增强工作计划性,提高医院工作效率,缓解患者＂看病难＂的矛盾.     

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。     

门诊医疗质控重点指标的构建与实践

目的 构建门诊医疗质控重点指标体系，以提高门诊医疗质量和患者满意度。方法 通过文献研究和专家访谈，形成咨询问卷，运用德尔菲法对17名专家进行两轮专家咨询，确立构建门诊医师医疗质控重点指标。提取医院HIS系统相关数据和移动终端满意度调查结果。结果 两轮专家函询的回收率均为100%,专家权威系数大于0.7,筛选后门诊医师质控重点指标体系包括3个一级指标、12个二级指标，指标问卷调查的克朗巴赫系数为0.728。从指标体系实践结果来看，预约挂号率增高了29.09%,基本药物占比增加了2.75%,门诊病历打印率增加了28.28%,出诊考勤合格率和患者满意度均有明显提升。结论 构建的医疗质控重点指标定位准确、导向性强，数据可量化，可用于门诊医疗质控，提升患者满意度。     

驻黎巴嫩维和部队医院门诊系统的改造与应用

本文报告了通过对国内使用的原门诊和挂号系统的改造,实现中国驻黎巴嫩维和二级医院门诊病历、处方及申请单的全英文书写和打印,实现了患者诊疗过程的电子化、网络化,提高了门诊医师的工作效率和服务质量。     

“和谐使命-2011”内科门诊特点分析和医师能力需求探讨

目的分析"和谐使命-2011"国外医疗服务内科门诊工作特点,探讨内科医师综合能力需求。方法回顾性分析门诊疾病总体分布情况;根据诊断结果分析内科疾病分布情况;分析内科门诊明确诊断的比率;对非明确诊断进行归类,统计各类症状或体征所占的比例;对专科医师接诊情况进行统计,分析专科医师接诊符合率。结果门诊内科患者最多,占总就诊量的28.82%;内科病种分布较广,心血管内科疾病最多,占35.95%;内科门诊诊断明确的占61.50%;非明确诊断患者中胸闷、胸痛类症状最多见,占31.03%;心血管内科和消化内科医师接诊本专科疾病符合率分别为28.46%和29.17%。结论内科门诊工作至少有两个特点:一是病种分布广;二是常以某一症状或体征为诊疗切入点。需要门诊内科医师具备一专多能的业务技能、较强的风险识别能力和风险应对能力。     

发挥门诊窗口在医疗优质服务中的作用

门诊是医院对外的一个窗口,也是直接对患者进行诊疗、咨询、预防保健的场所。其医疗质量的高低,服务水平的优劣,就诊环境的好坏,直接影响医院的信誉和发展。近年来,我院就诊患者日益增多,工作流程环节多,致使候诊时间长。为适应医疗制度的改革步伐,门诊工作必须与全院医疗工作同步前进。针对门诊工作特点和存在的问题,谈谈我们的做法和体会:1 消除就诊“三长一短”现象:①实行分科挂号:改变集中挂号为科挂号,挂号时间提前1h;由导医和分诊台工作人员维护秩序,基本做到不排队。②处方划价、收     

公立医院改革对某驻地军队医院门诊费用的影响

 目的 根据公立医院的改革政策,重点分析其对驻地军队医院门诊医疗费用的影响,为军队医院参与城市公立医院综合改革试点提供决策依据。方法 收集武警江苏总队医院2005—2015年门诊就诊人次,利用SAS 9.3软件对门诊人次构成比、门诊不同身份、费别、性别及年龄患者门诊次均费用进行数据分析与研究。结果 (1)次均费用呈逐年递增趋势,年均增长率为9.7%;(2)门诊患者中地方人员占绝大多数,为95.6%,且地方患者和军队患者的门诊费用差异有统计学意义(Z＝47.2066,P<0.0001);(3)自费患者占门诊例数最多为84.0%,其次为城镇医保患者10.3%,且不同费别患者的门诊费用有统计学差异(χ²=41624.2737,P<0.0001);(4)男性患者占总门诊人次的54.4%,高于女性患者,且不同年份男性与女性构成比差异有统计学意义(CMH＝40.6312,P<0.0001);(5)门诊患者中人数最多的为35~59岁年龄组(49.6%),且不同年份年龄构成比差异有统计学意义(χ²=2701.3116,P<0.0001)。结论 该地区根据实际情况制定的医保政策起到了控制医疗费用过快增长的作用,在国家公立医院改革背景下,军队医院军民融合式发展是解决军队医院发展瓶颈问题的有效形式。     

空军基层官兵口腔医疗服务现状的调查分析

目的了解空军基层官兵的口腔医疗服务现状,为进一步为空军部队官兵提供口腔诊疗服务提供依据。方法根据空军部队实际需要,制定针对口腔卫生保健行为以及口腔医疗需求的问卷,对4 925名空军官兵的口腔就诊情况进行问卷调查并分析。结果空军基层官兵中“从未看过牙”者居多,共3 159人(64.1%),其中又以义务兵所占比例最高(75.0%),差异有统计学意义(χ²=106.843,P<0.05);“看过6次及以上”的军官所占比例最高(χ²=86.954,P<0.05)。59.9%的官兵能在1 h内获得诊疗,10.8%的人员能在1～4 h获得诊疗,6.2%当天就可以获得诊疗。对就诊机构级别不清楚的官兵较多,所占比例为80.1%;官兵就诊机构以团卫生队居多,占7.7%;在军区总医院口腔科就诊人数较少,仅占2.6%;也有部分官兵选择地方医院口腔科(2.9%)或私人牙科诊所(0.4%)。不治疗口腔疾病的原因中,多数义务兵选择“口腔医师预约困难”(21.5%),其次为军士(18.0%)和军官(14.9%),差异有统计学意义(χ²=7...     

医院门诊药房发生药患纠纷原因及对策

药房是患者医疗活动过程中的最后环节,也是最易发生医患纠纷的场所[1]。发药过程中稍有不慎,患者就有可能将诊疗过程中排队挂号、排队看病等其他环节产生的怨气渲泄出来。解决药患纠纷对提升医院的整体形象、提高患者的满意率、为患者构建和谐的就医环境意义重大。综合几家综合性三级甲等医院的情况,简要分析医院门诊药房发生药患纠纷的原因及对策。1药患纠纷的原因1.1医师不尽职原因:(1)电子处方打印错误。患者多,电子处方操作稍不仔细就会出现包括剂量、规格、用法、用量错误,而这些内容是处方法定内容,是不能有错误的。处方不正确,患者不…     

某三甲医院2010年统计年报分析

目的充分了解某院诊疗病人的特点,为制定医院工作计划和决策管理提供依据。方法从门诊工作、住院工作、工作质量三个方面对该院2010年统计年报进行分析。结果 2010年门诊人次、出院人次和手术人次增长明显;病床使用率比上年下降8.38%;出院病人中青壮年患者所占比例较大,男女性别比1∶0.833;医疗保健服务辐射鄂、豫、陕、渝毗邻地区;出院病人疾病分类前5位系统疾病分别是：消化系统疾病、循环系统疾病、呼吸系统疾病、损伤中毒和外因疾病、泌尿生殖系统疾病。全年死亡病人225例,病死率为0.35%。诊断质量、治疗质量指标均较好地达到＂三甲＂医院标准。结论 2010年该院医疗业务运行情况良好,但床位使用率偏高,应注意加强基础设施建设。同时,还要突出专科特色,凝炼学科方向,完善学科体系,提高整体实力。     

An investigation into why patients do not attend for out-patient radiology appointments

IntroductionPatients who do not attend (DNA) for out-patient hospital appointments cause delays in the diagnosis and subsequent treatment of their own, and other patient's, illnesses, with potentially hazardous consequences. This also impacts upon waiting lists.Failure to attend is viewed as a specific type of non-compliance and social cognition theories have been applied to previous studies in an attempt to uncover the reasons why patients choose not to keep their appointments.MethodsA case-control study was conducted throughout the X-ray departments of a District General type of NHS Trust, using telephone interview questionnaires based on the Health Belief Model, in an attempt to identify any significant differences between attenders and non-attenders, so that likely non-attenders could be targeted.ResultsPrincipal reasons for non-attendance were that the patient forgot or that they did not receive their appointment. The results differed from previous research, in that specific health beliefs were not the primary reasons for non-attendance. Departments that gave patients the opportunity to arrange their appointments for a mutually convenient time had exceptionally low DNA rates, as did those which had rigorous confirmation systems in place.     

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.     

Impact of Delayed Time to Advanced Imaging on Missed Appointments Across Different Demographic and Socioeconomic Factors

PurposeThe aim of this study was to investigate the impact of wait days (WDs) on missed outpatient MRI appointments across different demographic and socioeconomic factors.MethodsAn institutional review board–approved retrospective study was conducted among adult patients scheduled for outpatient MRI during a 12-month period. Scheduling data and demographic information were obtained. Imaging missed appointments were defined as missed scheduled imaging encounters. WDs were defined as the number of days from study order to appointment. Multivariate logistic regression was applied to assess the contribution of race and socioeconomic factors to missed appointments. Linear regression was performed to assess the relationship between missed appointment rates and WDs stratified by race, income, and patient insurance groups with analysis of covariance statistics.ResultsA total of 42,727 patients met the inclusion criteria. Mean WDs were 7.95 days. Multivariate regression showed increased odds ratio for missed appointments for patients with increased WDs (7-21 days: odds ratio [OR], 1.39; >21 days: OR, 1.77), African American patients (OR, 1.71), Hispanic patients (OR, 1.30), patients with noncommercial insurance (OR, 2.00-2.55), and those with imaging performed at the main hospital campus (OR, 1.51). Missed appointment rate linearly increased with WDs, with analysis of covariance revealing underrepresented minorities and Medicaid insurance as significant effect modifiers.ConclusionsIncreased WDs for advanced imaging significantly increases the likelihood of missed appointments. This effect is most pronounced among underrepresented minorities and patients with lower socioeconomic status. Efforts to reduce WDs may improve equity in access to and utilization of advanced diagnostic imaging for all patients.     

Communicating Mammography Results: By What Method and How Quickly Do Women Want Their Screening Mammogram Results?

The purpose of the survey study was to understand the majority preference with regards to the wait time for screening mammogram results, whether prompt communication of mammogram results was of importance to patients, whether the time frame to schedule an additional imaging follow-up appointment after an abnormal screening mammogram was important to patients, and how patients preferred to be given their screening mammogram results. There were 2,245 patients who participated in the survey. A majority of patients preferred to receive screening mammogram results on Friday (n = 1,868, 85.4%), even if their mammogram was abnormal, requiring a follow-up appointment that could not be scheduled until the following week. Most individuals preferred to schedule their follow-up appointments soon after their initial appointment, preferring either the next day or within 1 to 2 days. Finally, over half of the sample preferred to be contacted via a telephone call, with letter and text messaging being the next most preferred methods and e-mail being the least preferred. Survey results suggest that the preferred wait time for screening mammogram results was either to wait at the time of screening mammogram appointment or to receive results within 48 hours. These suggestions can help clinics and providers make changes to how they communicate screening mammogram results. The strong preference of patients receiving their screening mammogram results more promptly should help trigger alternative methods toward improving communication between the radiologist and the patient.     

Does the Combination of Phone,Email and Text-Based Reminders Improve No-show Rates for Patients in Breast Imaging?

The issue of no-shows in radiology is complicated and challenging. Mammography and ultrasound have the highest rate of no-shows among radiologic exams. Screening mammography is one of the most cost-effective ways to reduce breast cancer related deaths. However, the benefit of screening is heavily dependent on patient compliance to routine exams. Enhancing patients’ commitments to their scheduled appointments, thereby improving early detection and decreasing breast cancer related mortality. Retrospective analysis of no-show visits scheduled from August 2017 to December 2017 (before the implementation of combined phone, email and text-based reminders) and from August 2019 to December 2019 (after the implementation of reminder and follow-up phone calls after missed appointments by the coordinator) in an urban academic breast imaging center was conducted. There were 368 no-show patients in 2017 and 238 no-show patients in 2019. Percentage of no-shows, and delay time to the rescheduled missed appointment were calculated. Subgroup analysis of the type of studies that were missed and those who did not reschedule the missed appointment was conducted. Mann Whitney U test was used to analyze differences between group means. No-show visits decreased by 50% in 2019 when compared to 2017. The average wait time between the missed appointment and the rescheduled appointment decreased significantly from 30.7 weeks in 2017 to 12.1 weeks in 2019 (P = 0.047). The percentage of no-show visits was highest among the unemployed, patients scheduled for screening mammograms and patients with a high average of no-show visits. No-show visits adversely impact patient outcome and contribute to increased cost of healthcare. Through a deeper understanding of the factors contributing to no-shows, we can strive to make appropriate interventions to alleviate the consequences of no-shows.     

Provision of forensic medical services to police custody suites in England and Wales: Current practice

IntroductionPolice services within England and Wales are required under the Police and Criminal Evidence Act 1984 to ensure appropriate healthcare to those detained in police custody (forensic medical services). Traditionally doctors have been used by police services to provide an appropriate level of care. Changes within the Act allowed other healthcare professionals (nurses and paramedics and emergency care practitioners) to be included in the provision of such services. The aim of this appears at least in part to have been to reduce the costs of providing such a service. In recent years police services within England and Wales have been outsourced to assorted commercial providers. There are now several different modes of delivery of forensic medical services, which are determined locally by separate police services.AimsThis study aimed (a) to determine the different modes of delivery of forensic medical services in England and Wales; (b) to determine the healthcare workload caused by Police and Criminal Evidence Act 1984 Codes of Practice; (c) to determine the relative costs of different service models and (d) to determine availability of such information from the police services.MethodsThe study was undertaken in two parts – (a) a telephone survey of all police services, and (b) an application to each police service utilising the Freedom of Information Act 2000.ResultsAll police services (n = 43) in England and Wales were contacted. Of the 41forces that furnished detailed information; 13/41 had a doctor only service; 20/41 had a doctor/nurse service; 6/41 had a doctor/nurse/paramedic service; 1/41 had a doctor/emergency care practitioner service (who may be nurses or paramedic); 1/41 had a doctor/paramedic service. 23/43 services were outsourced to private commercial providers. Mean cost per patient contact (in 17/43 services which supplied data) was GBP 97.25. The cheapest cost per patient contact was the Metropolitan Police Service – a doctor only service (GBP 56.4), the highest Lincolnshire – a doctor only service (GBP 151.1). Mean cost for a doctor only service was GBP 97.1; for a doctor/nurse service – GBP 91.56 and for a doctor/nurse/paramedic service – GBP 115.76. There was no significant difference in costs per patient contact between a doctor only versus mixed HCP delivery of service. Relative costs and 95% confidence intervals expressed as a percentage show that a doctor only model was on average 3.4% lower than a mixed HCP provision, and that a non-outsourced service was on average 9.9% less than an outsourced service. No outsourced service in this study uses a doctor only model.ConclusionsThe study shows that there was a complete lack of consistency in the recording and availability of information regarding forensic medical services for police services in England and Wales. The information that was obtained suggested that usage of such services varied greatly between police services and that costs of forensic medical services appear to be increased by the use of mixed healthcare professional service delivery and by using external commercial providers.     

The impact of a nursing triage line on the use of emergency department services in a military hospital

The purpose of this study was to evaluate the impact of nursing telephone triage on the appropriateness of emergency department (ED) use among 563 patients at a military hospital by comparing 286 ED patients referred by the Tel-a-Nurse Line (TAN) with 277 non-TAN-referred patients from October 2000 to November 2000. When controlling for confounding factors, TAN-referred patients had less appropriate ED use than non-TAN-referred patients, although this was not statistically significant (odds ratio = 0.87, p = 0.452). After excluding TAN patients with a primary clinic disposition but who were directed to the ED because no clinic appointments were available, TAN-referred patients had more appropriate referrals than non-TAN patients, although this was also not significant (odds ratio = 1.19, p = 0.401). TAN patients directed to the ED because of clinic appointment unavailability contributed significantly to inappropriate ED use with 62% having low acuity. This finding underscores the need to evaluate clinic availability for the TAN line and possibly for all patients as well.