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Health Informatics Journal Dec 2020Scheduling of resources and patients are crucial in outpatient clinics, particularly when the patient demand is high and patient arrivals are random. Generally,...
Scheduling of resources and patients are crucial in outpatient clinics, particularly when the patient demand is high and patient arrivals are random. Generally, outpatient clinic systems are push systems where scheduling is based on average demand prediction and is considered for long term (monthly or bimonthly). Often, planning and actual scenario vary due to uncertainty and variability in demand and this mismatch results in prolonged waiting times and under-utilization of resources. In this article, we model an outpatient clinics as a multi-agent system and propose an intelligent real-time scheduler that schedules patients and resources based on the actual status of departments. Two algorithms are implemented: one for resource scheduling that is based on predictive demand and the other is patient scheduling which performs path optimization depending on the actual status of departments. In order to match resources with stochastic demand, a coordination mechanism is developed that reschedules the resources in the outpatient clinics in real time through auction-bidding procedures. First, a simulation study of intelligent real-time scheduler is carried out followed by implementation of the same in an outpatient clinic of Aravind Eye Hospital, Madurai, India. This hospital has huge patient demand and the patient arrivals are random. The results show that the intelligent real-time scheduler improved the performance measures like waiting time, cycle time, and utilization significantly compared to scheduling of resources and patients in isolation. By scheduling resources and patients, based on system status and demand, the outpatient clinic system becomes a pull system. This scheduler transforms outpatient clinics from open loop system to closed-loop system.
Topics: Ambulatory Care Facilities; Appointments and Schedules; Computer Simulation; Humans; India; Outpatients
PubMed: 32081068
DOI: 10.1177/1460458220905380 -
Inquiry : a Journal of Medical Care... 2022To explore the application of plan-do-check-action (PDCA) cycle management model in the management outpatient appointment, and improve the efficiency of outpatient...
To explore the application of plan-do-check-action (PDCA) cycle management model in the management outpatient appointment, and improve the efficiency of outpatient appointment services. The data of outpatients from January 2019 to December 2020 were collected from a tertiary class B general hospital affiliated to a university in Shanghai. Through the investigation and analysis of the current situation, the reasons were found for the low rate of outpatient appointment. PDCA management was carried out, and measures were formulated for continuous improvement and the effective measures were standardized. The appointment rate, recognition rate and the utilization rate of self-service appointment (handheld hospital and self-service machine) were analysed after the intervention of PDCA. Through PDCA cycle management model, the appointment rate of outpatients increased from 9.93% before improvement to 82.50% after improvement, and the recognition rate of patients increased from 51.39% to 92.76%. The utilization rate of self-service appointment increased from 1.03% to 56.38%. Through the construction of multi-channel, wide coverage and convenient operation of the appointment service system, the PDCA cycle management model effectively improves the efficiency of the outpatient appointment services.
Topics: Ambulatory Care; Appointments and Schedules; China; Humans; Outpatients; Tertiary Care Centers
PubMed: 35527715
DOI: 10.1177/00469580221081407 -
Cardiovascular and Interventional... Oct 2022To compare the safety of outpatient versus inpatient endovascular treatment of lower extremity arterial disease (LEAD) using real-life data. (Observational Study)
Observational Study
PURPOSE
To compare the safety of outpatient versus inpatient endovascular treatment of lower extremity arterial disease (LEAD) using real-life data.
MATERIALS AND METHODS
This retrospective observational study used real-life data from the French national health data information system on adult patients who underwent stenting for LEAD between 2013 and 2016. The outcomes of interest were all-cause mortality, all-cause hospitalization, planned hospitalization, and unplanned hospitalization at day 3 and day 30 after the index endovascular intervention for LEAD revascularization. A propensity score was used to control for indication bias. Outcome rates in outpatient and inpatient settings were compared with the Poisson regression model. Sensitivity analyses were performed by varying the definition of the outcomes of interest.
RESULTS
During the study period, 26,715 interventions were performed among which 2819 (10.6%) were in outpatient settings. Outpatients were slightly younger than inpatients (64.73 ± 10.68 vs. 68.10 ± 11.50, respectively). The percentage of women patients was similar: 19.8% in the outpatient group and 27.2% in the inpatient group. Within 30 days after discharge, 73 patients (.31%) and 2 (.07%) patients (p = .02) died in the inpatient group and outpatient group, respectively. The death and rehospitalization rate were similar: 3.8 and 3.5 per 1000 person-months for inpatients and outpatients, respectively. No difference was observed after adjusting for patients' case-mix in the regression model (RR = .99; 95% CI [.82-1.19]).
CONCLUSIONS
Outpatient stenting for LEAD did not present any additional risk of early postoperative rehospitalization or death compared with inpatient stenting.
Topics: Adult; Female; Hospitalization; Humans; Inpatients; Lower Extremity; Outpatients; Postoperative Complications; Retrospective Studies; Stents
PubMed: 35732932
DOI: 10.1007/s00270-022-03193-0 -
BMC Health Services Research Nov 2023Unnecessary delays in patient discharge from hospital outpatient clinics have direct consequences for timely access of new patients and the length of outpatient waiting...
BACKGROUND
Unnecessary delays in patient discharge from hospital outpatient clinics have direct consequences for timely access of new patients and the length of outpatient waiting times. The aim of this study was to gain better understanding of hospital doctors' and general practitioners' perspectives of the barriers and facilitators when discharging from hospital outpatients to general practice.
METHODS
An interpretative approach incorporating semi-structured interviews with 15 participants enabled both hospital doctors and general practitioners to give their perspectives on hospital outpatient discharge processes.
RESULTS
Participants mentioned various system problems hampering discharge from hospital outpatient clinics to general practice, such as limitations of electronic communication tools, workforce and workload challenges, the absence of agreed discharge principles, and lack of benchmark data. Hospital clinicians may keep patients under their care out of a concern about lack of follow-up and an inability to escalate timely hospital care following discharge. Some hospital clinicians may have a personal preference to provide ongoing care in the outpatient setting. Other factors mentioned were insufficient supervision of junior doctors, a patient preference to remain under hospital care, and the ease of scheduling follow-up appointments. An effective handover process requires protected time, a systematic approach, and a supportive clinical environment including user-friendly electronic communication and clinical handover tools. Several system improvements and models of care were suggested, such as agreed discharge processes, co-designed between hospitals and general practice. Recording and sharing outpatient discharge data may assist to inform and motivate hospital clinicians and support the training of junior doctors. General practitioners participating in the study were prepared to provide continuation of care but require timely clinical management plans that can be applied in the community setting. A hospital re-entry pathway providing rapid access to outpatient hospital resources after discharge could act as a safety net and may be an alternative to the standard 12-month review in hospital outpatient clinics.
CONCLUSION
Our study supports the barriers to discharge as mentioned in the literature and adds the perspectives of both hospital clinicians and general practitioners. Potential solutions were suggested including co-designed discharge policies, improved electronic communication tools and a rapid hospital review pathway following discharge.
Topics: Humans; General Practitioners; Outpatients; Patient Discharge; Australia; Hospitals
PubMed: 37940986
DOI: 10.1186/s12913-023-10221-3 -
American Family Physician Feb 2022
Topics: Cervical Ripening; Female; Humans; Labor, Induced; Outpatients; Oxytocics; Pregnancy
PubMed: 35166490
DOI: No ID Found -
Innere Medizin (Heidelberg, Germany) Sep 2022Reforms of emergency and after hours care have been on the health policy agenda for years, and continue to remain there in the present government's program. In order to... (Review)
Review
Reforms of emergency and after hours care have been on the health policy agenda for years, and continue to remain there in the present government's program. In order to outline where this originates from, we provide a brief summary of past reform steps and a claims data analysis of ambulatory and inpatient emergency and after hours care. Given that previous reform steps have been triggered by increases in emergency department utilization by low acuity cases that could have been treated by office-based physicians during office hours or in after hours care, we analyze the ambulatory and inpatient claims data in the past decade prior to the pandemic (2010-2019). The result shows increases until 2015. Thereafter, the overall case load in emergency wards has levelled, while outpatient cases in emergency wards have decreased. This effect cannot safely be attributed to elements of demand management such as after hours practices in hospitals and telephone triage that have been implemented since then. The distribution of diagnostic codes in claims data suggests that emergency wards and after hours practices have reached a clear division of labor. A continuous shift of patients in age groups 70+ into ambulatory care in emergency wards suggests that this division of labor needs to be further elaborated. Past legislation has not yet been fully implemented. In particular, it is necessary to decide which triage system emergency wards will need to use to identify low acuity patients for redirection into ambulatory care. We argue that implementation and evaluation of these requirements should be completed before further far reaching reforms are enacted.
Topics: Ambulatory Care; Emergency Medical Services; Emergency Treatment; Humans; Outpatients; Triage
PubMed: 35925125
DOI: 10.1007/s00108-022-01382-0 -
BMJ Open Sep 2023The implementation of outpatient training in primary care settings is an essential part of residency training for general practitioner (GP) residents. However, limited...
OBJECTIVES
The implementation of outpatient training in primary care settings is an essential part of residency training for general practitioner (GP) residents. However, limited research exists on their experiences and perceptions of this training. This study aimed to explore the experiences and perceptions of GP residents regarding outpatient training in primary care settings in China and provide insights and recommendations to enhance training quality.
DESIGN
A qualitative descriptive study employing in-depth interviews.
SETTING
Two community healthcare centres (CHCs) that implement outpatient training programmes for GP residents in Zhejiang Province, China.
PARTICIPANTS
In total, 20 GP residents affiliated with 14 CHCs and two hospitals across Zhejiang Province and Guizhou Province who had completed outpatient training in either CHC for over 1 month.
RESULTS
Of the 20 participants in this study, 11 (55%) were women, and the mean age was 28 years. GP residents completed the process of consultation, physical examination and therapy independently; subsequently, the community preceptors provided feedback based on their clinical performance and modelled their clinical skills. The benefits perceived by GP residents included improved clinical skills and confidence in practice, and they learned approaches to maintaining good relationships with patients. They preferred dealing with complex cases, discussions with peers and the indirect supervision of community preceptors in the training session. Residents recommended that measures be taken to improve the training quality regarding patient selection and recruitment, clinical skills in the training session, and assessment of clinical performance.
CONCLUSIONS
The outpatient training in primary care settings provides constructive opportunities for GP residents to improve their professional competencies. Although the current training sessions and the abilities of community preceptors largely satisfy the needs of GP residents, further research is needed to evaluate the effectiveness of training and explore approaches to improve its quality.
Topics: Humans; Female; Adult; Male; Outpatients; General Practitioners; Learning; China; Primary Health Care
PubMed: 37714679
DOI: 10.1136/bmjopen-2023-076821 -
Acta Orthopaedica Oct 2023
Topics: Humans; Arthroplasty, Replacement, Knee; Outpatients; Arthroplasty, Replacement, Hip; Postoperative Complications
PubMed: 37830939
DOI: 10.2340/17453674.2023.21318 -
Journal of the American Heart... Jul 2020
Topics: Diuretics; Heart Failure; Humans; Outpatients
PubMed: 32662304
DOI: 10.1161/JAHA.120.017485 -
Revista Gaucha de Enfermagem 2022To know the performance of nursing professionals in accredited outpatient radiology and diagnostic imaging services.
OBJECTIVE
To know the performance of nursing professionals in accredited outpatient radiology and diagnostic imaging services.
METHODS
Exploratory, qualitative study, conducted in January 2019, through interview with 21 coordinators in three outpatient imaging services in the Southeast region of Brazil. A textual corpus was formed and processed by a software and the data was analyzed using Reinert's method.
RESULTS
After the organization of the content, two thematic blocks were elaborated: nursing assignments when assisting imaging exams, with three classes with similar content; and nursing and patient safety in radiology, with two classes with similar content.
CONCLUSION
Nursing had a relevant role in quality management, developing actions to mitigate risks and damages, recording and managing adverse events and acting in educational processes, focusing on the quality of care and of images from the perspective of patient safety.
Topics: Humans; Nursing, Team; Outpatients; Patient Safety; Qualitative Research; Radiology
PubMed: 35976377
DOI: 10.1590/1983-1447.2022.20210079.en