A delay-scheduling model for patients using a walk-in clinic

Clinics receiving unscheduled visits experience wide fluctuations in the number of patients present at any one time, due to random arrival of patients and variations in the time needed for the evaluation and treatment. This can cause periods of congestion and long patient waiting times. Using a flexible technique for “delay scheduling,” a study was conducted to determine the most efficient use of limited physician resources in the management of patients using a walk-in clinic. Delay scheduling makes it possible to shift work load from periods of high congestion to other times without compromising the walk-in nature of the clinic. A computer simulation model was used to evaluate the clinic performance with different physician staffing patterns and different rules for delay scheduling. The model was validated using actual data from the walk-in clinic and the results implemented. The delay scheduling and staffing changes resulted in reduction of manpower by 10% while significantly reducing the clinicaccountable waiting time.     

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.     

Closing Emergency Operating Rooms Improves Efficiency

Long waiting times for emergency operations increase a patient’s risk of postoperative complications and morbidity. Reserving Operating Room (OR) capacity is a common technique to maximize the responsiveness of an OR in case of arrival of an emergency patient. This study determines the best way to reserve OR time for emergency surgery. In this study two approaches of reserving capacity were compared: (1) concentrating all reserved OR capacity in dedicated emergency ORs, and (2) evenly reserving capacity in all elective ORs. By using a discrete event simulation model the real situation was modelled. Main outcome measures were: (1) waiting time, (2) staff overtime, and (3) OR utilisation were evaluated for the two approaches. Results indicated that the policy of reserving capacity for emergency surgery in all elective ORs led to an improvement in waiting times for emergency surgery from 74 (±4.4) minutes to 8 (±0.5) min. Working in overtime was reduced by 20%, and overall OR utilisation can increase by around 3%. Emergency patients are operated upon more efficiently on elective Operating Rooms instead of a dedicated Emergency OR. The results of this study led to closing of the Emergency OR in the Erasmus MC (Rotterdam, The Netherlands).     

某综合医院门诊患者满意度的调查研究

目的:了解某三甲医院门诊患者满意度的情况,探讨通过门诊患者满意度提高医疗服务质量和医院综合实力的方法和途径。方法:采用分层抽样的方法对门诊患者进行现场问卷调查和统计分析,获有效问卷239份。结果:患者对医院服务的总体满意度(得分3.73)较高;满意度较高的项目主要体现在医师医疗技术水平、医疗环境设施,满意度较低的项目主要集中在看病前等候时间和医疗收费等方面。在总满意度上,首次就诊的门诊患者明显高于多次就诊的患者,差异有统计学意义(F=10.084,P<0.01);不同年龄与医疗过程(F=6.814,P<0.01)、服务结果(F=3.262,P<0.01),不同文化程度与医疗过程(F=3.477,P<0.01),不同费用支付方式与环境设施(F=9.473,P<0.01),不同就诊次数与环境设施(F=9.218,P<0.01)、等候时间(F=12.419,P<0.01)、服务态度(F=5.115,P<0.01)和服务结果(F=7.643,P<0.01)比较均存在差异,且差异具有统计学意义。结论:该综合医院门诊患者满意度较好,年龄、文化程度、费用支付方式、就诊次数是满意度的影响因素。建议通过满足不同层次患者需求;进一步优化门诊流程;完善医院收费管理制度;进一步加大宣传力度,提高患者的忠诚度,提高服务满意度。     

医院分诊排队原理的分析比较和实践

利用计算机技术．针对不同分诊管理模式分别采用不同的分诊排队方案解决，如挂号处分诊、护理站分诊、二次候诊等方法进行自动分诊排队，分别解决了成人门诊、儿童门诊、儿童急诊等不同环境下的病人分诊问题，提高了工作效率，减少了病人排队次数和时间，保证了公正公平合理的等候秩序。     

门诊患者候诊需求满足现状调查

目的：了解综合医院门诊患者候诊时的需求及满足情况,为提升服务水平,最大限度地满足患者需求,提高患者满意度提供科学的依据。方法：对某院门诊候诊患者随机发放调查问卷,内容包括本次候诊过程的满意度、候诊时不满意事项、能接受的候诊时间、超过候诊时间预期的行为反应、候诊时最希望得到的服务。结果：61．52％的患者能接受的候诊时间为30分钟,92．04％的患者认为等候时间不能超过60分钟,如超过时间预期首先向分诊护士询问。候诊时患者最希望得到疾病相关知识的咨询服务：候诊满意度为75．46％,最不满意医生不按时开诊、医务人员带人插队。结论：患者候诊时的需求主要是候诊时间控制在60分钟内,候诊过程中应提供疾病相关知识的咨询讲座,分诊护士能耐心解答患者疑问、满足其合理诉求。     

规范出诊管理结合个性化预约号源设置提高门诊预约精准率

精准预约可以切实缩短患者的候诊时间,从而改善患者就医体验。要做到精准预约,与规范出诊医师管理及合理设置预约号源密不可分。浙江省丽水市中心医院结合实际,首先规范医师按时出诊;再将所有专家门诊和普通门诊均约到每位医师个人队列,方便患者选择医师预约就诊;然后按每个科室及每位医师平均看诊时长,个性化设置分时段预约号源间隔时间,提高预约精准率;最后,统计预约时间点与实际看诊时间点之差,获取平均候诊时长,针对候诊时间过长的医师号源进行分析改进,提高按时看诊率。经过1年半的调整,目前医院患者分时段预约精准率已达93%以上。     

基于医院信息系统平台下门诊流程再造的探讨

门诊是医院的重要服务窗口,患者挂号、收费、取药时间长,医生看病时间短等现象。始终困扰着医院。基于医院信息系统平台对门诊流程再造与优化,改变服务模式,缩短患者的等候时间,切实全面提高了门诊的医疗服务质量。     

门诊药房自动化调剂新模式的探索

传统的门诊病人取药流程繁琐，病人等待时间过长，还会引起不必要的医患纠纷。提出了一种全新的解决方法，在现有主营HIS业务系统的基础上，以外挂的形式开发了门诊语音自动司药系统，同时融合条码扫描技术，优化了门诊病人的取药流程，减少了病人等待时间，提高了药剂师的工作效率，具有很好的实际应用效果，对其它医院的信息化建设和发展也有一定的借鉴作用。     

运用信息化建设缩短门诊患者等待时间

通过运用门诊信息化建设对门诊患者等候时间的影响分析,总结出信息化建设对缩短门诊患者等候时间承担着巨大作用,有效提高了医院运营效率。就门诊信息化建设对患者就医各环节等候时间的改善进行分析,肯定了信息化建设对减少门诊就医等候时间,提高患者就医效率起到了决定性作用。     

大型综合性医院门诊患者需求调查分析

目的：分析门诊患者就医选择因素,探讨提高患者对门诊工作满意度的途径。方法：采用自行设计的问卷调查表对门诊患耆进行调查。结果：患者选择就诊医院时最看重的因素是医疗技术,患者对综合性医院门诊候诊时间和就医环境最不满意。结论：医院应提高医院信息系统利用效率,缩短候诊时间。做好医疗资源配置规划,改善就诊环境。     

门诊流程优化及效果的调查分析

目的：调查分析门诊业务流程的技术线路和各环节因素,优化设计新流程。方法：采用现状调查和实验对照研究,对某医院门诊患者抽样．测量计算门诊各基本环节因素的频次、耗时等,以确定相关因素对门诊流程的影响权重和流程优化的效果。结果：新流程有效缩短了患者就诊时间,提高了门诊工作量。结论：门诊流程优化效果显著,可在不扩大基础规模的情况下有效提高门诊工作效率和服务质量。     

人性化护理在门诊注射护理中的应用探讨

目的探讨人性化护理在门诊注射治疗护理中的应用。方法通过对2012年6—12月在我院门诊注射护理采用常规护理为对照组,2013年1-6月在我院门诊注射护理中常规护理基础上采用人性化护理为实验组。观察比较两组投诉率、患者的满意度、注射等候时间、护理质量评分及心理状态。结果实验组患者的投诉率较对照组患者明显降低,具有显著性差异（P〈0．05）,实验组患者的满意度较对照组患者明显提高,具有显著性差异（P〈0．05）;实验组患者注射等候时间较对照组患者明显降低,具有显著性差异（P〈0．05）,实验组护理质量评分较对照组明显提高,具有显著性差异（P〈0．05）;实验组患者的心理状态较对照组患者明显提高,具有显著性差异（P〈0．05）。结论针对门诊注射护理采用人性化护理可以显注提高护理效果,提高患者满意度,缓解患者不良心理,减轻患者痛苦。人性化护理在门诊注射护理中具有十分重要的临床意义,值得推广应用。     

医院信息系统门诊预交金模式的探讨

流程再造是医院信息系统的建设目标之一,而门诊预交金诊疗卡的实施则是门诊流程再造的一个重要举措。在门诊推行预交金模式,可以有效减少门诊病人排队次数,缩短病人等待时间。探讨了门诊预交金模式的流程及实现方法。并从患者、财务、医务人员三个角度进行了相关讨论。     

某医院门诊医患双方对预约挂号需求的调查研究

目的:了解某医院医患双方对于门诊服务中各环节的满意程度和预约挂号的需求和偏好,为促进医院预约挂号服务提出建议。方法:利用自设问卷收集资料,现场调查1000名门诊就诊患者、200名出诊医生对于门诊服务各环节满意程度和对于预约挂号的需求和偏好。结果:患者对于候诊时间与等待时间有关的服务环节满意度较低,医生对门诊服务流程满意度也较低;医患双方对医院现行预约挂号服务总体比较满意,但仅有35%的受访患者使用过预约挂号服务,54%的患者使用现场预约方式;不同的年龄、职业和文化程度的患者对挂号方式的偏好并不完全一致,对时间成本比较敏感的职业和年龄群体更倾向于能自主选择就诊时段的分时段预约挂号方式;超过90%的医生认为有必要提供各种形式的专家门诊预约挂号;仅57%的医生认为有必要在普通门诊开展复诊预约挂号。结论:候诊时间长已成为影响门诊服务满意度的重要因素,应采取措施继续提高预约挂号比例,预约挂号模式还需进一步探索和完善。     

基于网闸实现物理隔离的网上预约挂号系统

网络预约挂号正在逐渐普及,通过预约挂号,人们可以大大节省在医院排队挂号与排队就诊的时间.然而出于各种安全因素考虑,很多医院不愿把数据库服务器直接或间接与互联网连接.这样,需要维护人员通过移动媒介手工修改出诊时间和接收挂号人员信息,降低了工作效率.提出了一种基于网闸的物理隔绝的网络预约挂号系统,对比没有网闸的预约系统,有如下优势：出诊信息通过网闸同步到外网服务器;预约挂号患者的信息通过网闸同步到内网;预约服务窗口仅需确认挂号患者身份而无需连接外网.预约挂号系统无需人工维护即可完成预约挂号的全过程,提高了工作效率.     

基于Matlab的医院门诊候诊排队系统仿真研究

目的:运用上海某三甲医院门诊数据,建立基于Matlab的医院门诊候诊排队仿真模型。方法:依托HIS系统提取相关数据,经过统计检验并确定模型参数,编制普通门诊候诊排队系统Matlab仿真程序,模拟不同候诊模式下患者的候诊时间。结果:给出两种不同排队规则下患者候诊时间的模拟计算结果,并与M/M/C模型理论值和HIS系统采集的实际值进行比较,对该模拟方法的有效性进行考察和验证。结论:针对无法用解析法求解的复杂排队系统,可建立基于Matlab的仿真模型进行研究和决策支持。该模拟过程和编程方法通过扩展和修改,同样适用于分时段预约挂号后各种模式候诊队列的研究。     

Breast cancer recurrence: follow up after treatment for primary breast cancer

Background: Breast cancer will affect one in 12 Australian women in their lifetime. After potentially curative treatment, it is usual for patients to be followed up for many years. However, controversies surround follow up, and its value is uncertain. Aim: This study reviews the evidence and describes the role of routine follow up in the management of breast cancer in a tertiary hospital. By establishing how recurrence of breast cancer presents and identifying the proportion of patients with recurrence who were diagnosed as a consequence of regular follow up, the value of this system in detecting recurrence can be indirectly assessed. Design: A retrospective review was undertaken of all patients attending the radiotherapy outpatient clinic for treatment of invasive breast cancer in 1997. Hospital records were reviewed to ascertain patient and tumour characteristics, treatment received, site of recurrence and its mode of detection, whether patients were symptomatic at the time of recurrence, and whether they presented at a scheduled appointment. Results: Out of 286 patients who presented to the radiotherapy outpatient clinic, 220 were entered into the study. Recurrence was recorded in 42 patients (a complete dataset was available for 38 of these patients). In total, 74% (31/42) of recurrences were symptomatic, and 76% (32/42) presented at unscheduled appointments, the majority (17/32) of which were initiated by the patient. Only seven patients had asymptomatic recurrences. Conclusion: Based on current evidence, long term routine hospital follow up after treatment for breast cancer appears to be inefficient in detecting recurrence.     

实时结算“银医一卡通”模式的设计与实现

介绍一种实时结算模式的“银医一卡通”系统,利用普通银行卡代替门诊就诊卡,实现全自助模式的门诊挂号、缴费、预约等门诊就诊流程的优化,有效减少了病人排队等候时间,提高了病人满意度,是一种银行服务和医疗行业服务结合的新模式。     

全预约分时段服务模式的实施与效果评价

新的医疗服务模式利用信息化手段,在领导重视、制度健全的基础上,推行现场预约、电话预约、网络预约和诊间预约等多种预约挂号形式,专家号、专科号及普通号（急诊除外）均有具体候诊时问段,让患者减少挂号、就诊排队等候时间,并通过对号源、专家、患者的科学管理及全方位的宣传推广,取得了方便患者就诊、优化门诊秩序和建立医患诚信等效果,进一步促进了和谐医疗发展。