门诊预约患者满意度指标体系的建立及应用

目的根据不同的门诊预约模式建立综合医院门诊预约满意度测评指标体系,为医院门诊预约服务质量的评价与改善提供客观的测量工具。方法采用理论研究与实证分析相结合的研究方法。结果经文献回顾和实地调查初步选定23个满意度测评指标。在此基础上经专家咨询和实证调查,先后发放调查问卷603份,初步建立一个层层展开的三级医疗顾客满意度测评指标体系,形成综合医院门诊患者满意度调查问卷。结论根据调查结果对研究设计的调查表进行信度与效度检验,证明该满意度测评指标体系是可信和有效的。所开发的应用工具简单实用,可帮助医院改进门诊预约工作。     

医院门诊预约挂号爽约的现状及对策

目的综述医院门诊预约挂号爽约的现状和展望。方法通过查阅国内外相关文献资料,针对医院门诊预约挂号爽约的现状,分析其原因,采取积极有效的管理方法降低医院门诊预约挂号爽约率等进行综述。结果目前医院门诊预约挂号爽约率高,其原因有个人和综合等方面因素,分时段预约、实名制预约、付费预约等是防控爽约率的有效措施。结论针对医院门诊预约挂号高爽约率,通过有效管理控制预约爽约发生,同时对爽约号源充分再利用,以满足门诊患者的就诊需求,对提升医院门诊整体服务质量,构建和谐的医疗氛围具有积极促进的作用。     

复诊预约提高县级医院预约就诊率的实践

目的探索县级综合性医院预约诊疗服务模式,提高门诊预约就诊率。方法在门诊医生站、病区医生和护士工作站开设预约门诊项目,可直接为复诊或出院后复诊的病人预约下次就诊,促进医护人员对预约的宣传,完善预约管理机制,合理安排预约号与现场挂号的排序方式,全部门诊号推行时点式预约,落实预约优先就诊,建立对预约病人的短信或电话提醒,失约病人的追踪管理等措施。结果预约就诊率每月呈上升趋势,2011年3月到2012年4月共预约了20668人次,其中复诊预约方式占60.9%,普通门诊预约占73.8%。结论县级综合性医院通过开展复诊预约为主的方式带动普通门诊推广预约,是提高门诊预约就诊率的有效举措。     

灰色聚类在医院综合评价中的应用研究

本文应用灰色聚类方法对医院进行综合评价,并对标定聚类权进行了研究。要根据参加综合评价的指标作用情况不同,采用不同的计算方法计算标定聚类权,这是评价结果是否科学的关键问题。一般说来,不同类型指标在综合评价中作用大小是不一样的,为此,本文认为采用加权法计算标定聚类权,使判断结果更科学。     

基于密度聚类的医学图像分割及其局部特征提取

本文分析了一种实用于医学图像聚类分析的改进DENCLUE算法,用此算法先聚类出有器官语义意义的区域,再在聚类出的区域上,分别提取基于灰度直方图统计特征的均值、方差、倾斜度和峰度4个局部特征,这些局部特征能够更好地表示图像信息。     

上海部分三级医院预约服务现状调查

目的：了解目前公立医院预约挂号服务开展情况。方法：采用自制问卷调查和焦点组访谈方法。问卷调查分别对一家三级甲等综合医院和一家三级甲等专科医院的门诊患者进行调查。焦点组访谈了8家市级医院门诊办公室主任和数位医院管理专家。结果：本次调查397名患者,患者获得的预约平台预约信息主要来自医院方面的宣传,占56．9％。现场预约占34．5％,其次为电话预约和网上预约,分别占28．4％和29．O％。结论：虽然调查医院都实施了预约挂号改革,建立了统一的医联预约平台,但不同的医院原有的预约平台依然存在,在信息上存在着不对称性,患者选择时存在一定的盲目性。建议完善统一预约平台,进一步完善预约服务流程;加强预约服务人员培训,提高预约服务人员专业素质。     

优化预约诊疗服务效果分析

目的：优化改进门诊预约诊疗服务流程,进一步改善医疗服务。方法：选取2018年8月 1 日至10月31日和 2019年8月 1 日至10月31日两时间段我院门诊患者及家属各600名,进行门诊预约诊疗现场问卷调查,对优化改进前后预约率、爽约率、实名制率、迟到率及患者预约诊疗满意度进行对比分析。结果：流程优化后,预约率由43.9%增至60.9%;爽约率由33.34%降至10.82%;实名制率由47%上升至98.3%;迟到率由56.69%降至14.89%;患者满意度较优化前增长14.7%。结论：优化改进后的门诊预约诊疗服务取得了较好的效果,提升了患者的就诊满意度,提高了医院的工作效率和经济效益。     

简讯

卫生部副部长马晓伟在近期召开的全国预约诊疗服务工作电视电话会议上表示,各地所有三级医院普通门诊号源要开放预约,不低于85％的专家门诊号源要开放预约：到2012年6月底,原则上所有专家门诊号源全部开放预约。各医院对预约诊疗要实行“预约优先”,三级医院对社区卫生服务机构和有对口支援协作关系的县级医院预约转诊的患者优先安排就诊。     

疫情防控常态化下某中医医院门诊运行状况及思考

目的:分析某中医医院门诊运行情况,探讨疫情防控常态化下医院在做好防控工作时如何推进门诊诊疗服务.方法:对2019年、2020年医院门诊同期就诊情况进行统计学比较分析.结果:受新冠疫情影响,疫情前期医院门诊就诊人次大幅减少,随着疫情进一步控制,医院门诊就诊人次逐渐恢复正常;不同年龄段患者门诊就诊情况在疫情不同等级下呈现不同变化趋势;门诊就诊预约率提高,不同年龄段患者的预约率差异具有统计学意义.结论:公立医院应根据疫情形势的变化不断调整门诊服务,通过调整排班、加强预约渠道等方式合理分流门诊患者.     

用2种聚类法研究蜂产品中氯霉素筛选检测的安全限值

目的：找出ELISA法检测蜂产品原料中氯霉素的安全限值。方法：根据88组国内蜂产品生产商ELISA法检验结果和相应的秦皇岛蜂产品实验室LC—MS／MS法检验结果的数据样本，用层次聚类法和基于相似合成算法的聚类法对氯霉素含量的标准做进一步分析。结果：得出蜂产品生产商用ELISA法检验氯霉素含量的安全限值。结论：用ELISA法检测蜂产品原料中氯霉素时，应选择低于0．2～0．25ppb的产品加工。     

系统动力学在医院门诊预约患者管理中的应用研究

目的 从患者角度分析预约就诊过程,为提高医院门诊预约服务质量和服务效率提供支持.方法 采用系统动力学方法,分析预约就诊过程中的关键性因素及因素之间的关系,建立系统动力学模型.结果 将医务人员数量、患者候诊时间、诊疗时间等作为反映医院服务质量和服务效率的重要变量,构建系统动力学模型,根据模型提出缓解预约就诊困难的管理策略...     

医院门诊流程优化的调研统计分析与对策

目的 为了解门诊服务流程的现状和问题,进一步改善医疗服务质量,优化医院门诊服务流程。方法 现场统计“2013年2月第一周”和“2015年7月第一周”两个时段连续一周每天来四川大学华西医院门诊就诊的患者,每半小时统计一次,分析就诊各环节人流情况,进一步采取措施,优化就诊流程、强化分层就诊,整合窗口,细分号源预约时段和就诊时段。结果 门诊流程优化前,现场办卡、现场挂号、预约挂号、收费窗口及各候诊区人流量较大,尤其是候诊区等候的人群最高峰达3 720人,拥挤时间主要集中在9:00～11:30;门诊流程优化后,各窗口人流拥挤情况得到一定改善,患者满意度由原来的90.0%上升至93.5%。结论 医院门诊流程优化应根据患者的需求,关注细节,减少流程中的往返时间,缩短患者的等候时间,简化手续,才能改善患者的就医体验,最终提高患者满意度。     

Effects of clinical characteristics on successful open access scheduling

Many outpatient clinics are experimenting with open access scheduling. Under open access, patients see their physicians within a day or two of making their appointment request, and long term patient booking is very limited. The hope is that these short appointment lead times will improve patient access and reduce uncertainty in clinic operations by reducing patient no-shows. Practice shows that successful implementation can be strongly influenced by clinic characteristics, indicating that open access policies must be designed to account for local clinical conditions. The effects of four variables on clinic performance are examined: (1) the fraction of patients being served on open access, (2) the scheduling horizon for patients on longer term appointment scheduling, (3) provider care groups, and (4) overbooking. Discrete event simulation, designed experimentation, and data drawn from an intercity clinic in central Indiana are used to study the effects of these variables on clinic throughput and patient continuity of care. Results show that, if correctly configured, open access can lead to significant improvements in clinic throughput with little sacrifice in continuity of care.     

Dynamic multistage scheduling for patient-centered care plans

We investigate the scheduling practices of multistage outpatient health programs that offer care plans customized to the needs of their patients. We formulate the scheduling problem as a Markov decision process (MDP) where patients can reschedule their appointment, may fail to show up, and may become ineligible. The MDP has an exponentially large state space and thus, we introduce a linear approximation to the value function. We then formulate an approximate dynamic program (ADP) and implement a dual variable aggregation procedure. This reduces the size of the ADP while still producing dual cost estimates that can be used to identify favorable scheduling actions. We use our scheduling model to study the effectiveness of customized-care plans for a heterogeneous patient population and find that system performance is better than clinics that do not offer such plans. We also demonstrate that our scheduling approach improves clinic profitability, increases throughput, and decreases practitioner idleness as compared to a policy that mimics human schedulers and a policy derived from a deep neural network. Finally, we show that our approach is fairly robust to errors introduced when practitioners inadvertently assign patients to the wrong care plan.

     

医院门诊预约挂号的现状分析

目的 分析医院开展预约挂号的效果.方法 分析预约挂号在我院门诊挂号比例,对比分析不满意率、分诊不准确率的变化情况.结果 预门诊患者13 082例中,预约挂号占9.02％.预约挂号组1 180例中34例不满意、29例分诊错误;常规组11 902例中1 582例不满意、964例分诊锚误;两组经x2检验,不满意率(x2 =107.47,P＜0.05)、分诊不准确率(x2=48.72,P＜0.05),两项均差异有显著意义.结论 采用预约挂号提高了门诊就诊质量和工作效率,有利于建立良好的医患关系,提高患者满意度及分诊准确率,对于增强医院的核心竞争力起到了重要的作用.     

门诊预约管理策略评估研究

目的评估分时段预约挂号模式,综合考虑预约时段、排队规则等因素对患者候诊时间的影响。方法基于2016年4月—8月上海某三甲医院某科室普通门诊预约数据,应用排队论和Arena仿真软件建立不同预约号源管理方案模型并求解。结果结合实践需求,提出预约时段长度缩减、非预约局部分立排队及两者混合等3种改善方案,与原预约方案比较显示,非预约患者等候时间由原来的110min分别降为103min、108min、99min。结论3种预约改进策略,经仿真评估后采用了混合策略进行实施,提高了患者综合满意度,促进了门诊患者有序就诊。     

Using no-show modeling to improve clinic performance

'No-shows' or missed appointments result in under-utilized clinic capacity. We develop a logistic regression model using electronic medical records to estimate patients' no-show probabilities and illustrate the use of the estimates in creating clinic schedules that maximize clinic capacity utilization while maintaining small patient waiting times and clinic overtime costs. This study used information on scheduled outpatient appointments collected over a three-year period at a Veterans Affairs medical center. The call-in process for 400 clinic days was simulated and for each day two schedules were created: the traditional method that assigned one patient per appointment slot, and the proposed method that scheduled patients according to their no-show probability to balance patient waiting, overtime and revenue. Combining patient no-show models with advanced scheduling methods would allow more patients to be seen a day while improving clinic efficiency. Clinics should consider the benefits of implementing scheduling software that includes these methods relative to the cost of no-shows.     

Optimal outpatient appointment scheduling

In this paper optimal outpatient appointment scheduling is studied. A local search procedure is derived that converges to the optimal schedule with a weighted average of expected waiting times of patients, idle time of the doctor and tardiness (lateness) as objective. No-shows are allowed to happen. For certain combinations of parameters the well-known Bailey-Welch rule is found to be the optimal appointment schedule.     

风险评估体系在不同科室医院感染分类管理中的运用

 目的 在新型冠状病毒肺炎疫情常态化防控的形势下,建立一套全面、科学的风险评估体系,为医院管理决策提供支持。 方法 以山东省某综合性三级甲等医院为研究对象,首先进行全院整体层面的风险评估,由医院感染管理委员会成员采用头脑风暴的方法确定风险点和风险指标,通过风险评估矩阵计算出临床科室的风险分值,使用百分位数法对其进行风险等级评定,使用单因素方差分析或非参数检验比较不同风险组的差异,根据风险点的风险分值差异对临床科室进行分层聚类分析,再由评估出的极高风险科室使用失效模型和效应分析进行内部风险评估,最终根据两轮风险评估的结果进行风险应对。 结果 共61个临床科室参与评定。临床科室通过风险评估最终评定出8个风险点,24项风险指标。风险等级评估结果显示,神经外一科、神经外二科、神经重症监护病房、呼吸重症监护病房、重症医学科属于极高风险组,占8.20%;6个风险组的管理指标、过程指标和结局指标风险分值的比较,差异均有统计学意义(均P＜0.05);层次聚类分析将临床科室分为3类,根据其特点分别定义为普通科室聚类组、重点科室聚类组和神经外科聚类组。极高风险科室通过内部风险评估评出7个高风险优先级问题,并有针对性地提出解决方案。 结论 本研究构建的风险评估体系可以对临床科室的风险等级进行有效的评定和分析,对极高风险科室的高风险优先级问题能进行有效风险应对,能明确下一步医院感染管理的重点。     

Improving outpatient clinic efficiency using computer simulation

To assess and plan alterations in outpatient clinic structure, produces a computer simulation of an outpatient clinic based on detailed time and role measurements from the authors' clinic. The stimulation which used an object-oriented design method is able to indicate the impact of changes in clinic structure using patient and doctor waiting times in clinic as endpoint measures. The effects of changes in clinic size, consultation time, patient mix, appointment scheduling and non-attendance were examined. We found that patient waiting time could be shortened considerably by using an optimizing appointment scheduler to determine appointment intervals. Clinic mix influences patient waiting time, which was shorter with a 1 in 4 ratio of new to follow-up patients. In mixed clinics, new patients appointments are optimally spread throughout the clinic to reduce patient waiting time. In all new or all follow-up clinics, waiting time is improved if the appointment interval reflects the consultation time. Computer modelling can help in optimizing clinic management so improving the delivery of care in outpatient services.