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Dermatology (Basel, Switzerland) 2017The decision to discharge is a critical and common outpatient consultation event. However, little guidance exists over how discharge decision-making can be taught. We... (Review)
Review
BACKGROUND/AIMS
The decision to discharge is a critical and common outpatient consultation event. However, little guidance exists over how discharge decision-making can be taught. We aimed to provide educational recommendations concerning outpatient discharge decision-making.
METHODS
Recommendations were drawn from prior interviews with 40 consultant dermatologists and 56 dermatology outpatients, and from the "traffic light" design discharge information checklist, developed using the Delphi technique.
RESULTS
The key strategies to follow to appropriately manage the outpatient discharge process are: to warn patients in advance, to understand patients' agendas, to allow extra time for the discharge process, to prepare patients to self-manage, to provide a "safety net" and provide the GP with a clear management plan. Aspects to be considered include patient mobility, presence of carer, type of employment, diagnostic certainty, and use of the checklist or guidelines. Key training aspects include teaching structured thought processes when discharging, discharging according to context, developing communication and negotiation skills, avoiding decision biases and encouraging good interprofessional collaboration. Training should include the consideration of the possibility of discharge at each consultation. Novel training strategies have been developed on how to appropriately manage the outpatient discharge process, including involving and informing patients. These strategies focus on safe decision-making, being patient-centred and organizing an efficient health care service framework.
CONCLUSION
Structured outpatient discharge training for dermatologists is now possible, based on information from detailed doctor- and patient-based qualitative studies.
Topics: Clinical Competence; Decision Making; Dermatology; Humans; Outpatients; Patient Discharge; Patient Education as Topic; Referral and Consultation
PubMed: 28992624
DOI: 10.1159/000479060 -
Journal of Orthopaedic Surgery and... Sep 2020Careful pre- and post-operative management can allow surgeons to perform outpatient TKA, making this a more affordable procedure. The aim of the present meta-analysis is... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Careful pre- and post-operative management can allow surgeons to perform outpatient TKA, making this a more affordable procedure. The aim of the present meta-analysis is to compare outpatient and inpatient TKA.
METHODS
A systematic search of the literature was performed in July 2020 on PubMed, Web of Science, Cochrane library, and on the grey literature databases. The papers collected were used for a meta-analysis comparing outpatient and inpatient TKA in terms of complication and readmission rates. Risk of bias and quality of evidence were defined according to Cochrane guidelines.
RESULTS
The literature search resulted in 4107 articles; of these, 8 articles were used for the meta-analysis. A total of 212,632 patients were included, 6607 of whom were TKA outpatients. The overall complication rate for outpatient TKAs was 16.1%, while inpatient TKAs had an overall lower complication rate of 10.5% (p = 0.003). The readmission rate was 4.9% in outpatient TKAs and 5.9% in inpatient TKAs. Only 3 studies reported the number of deaths, which accounted for 0%. The included studies presented a moderate risk of bias, and according to GRADE guidelines, the level of evidence for complications and readmissions was very low.
CONCLUSIONS
This meta-analysis documented that outpatient TKA led to an increased number of complications although there were no differences in the number of readmissions. However, future high-level studies are needed to confirm results and indications for the outpatient approach, since the studies currently available have a moderate risk of bias and a very low quality of evidence.
Topics: Ambulatory Surgical Procedures; Arthroplasty, Replacement, Knee; Female; Humans; Inpatients; Male; Outpatients; Patient Readmission; Postoperative Complications; Quality of Health Care; Risk; Risk Assessment
PubMed: 32928278
DOI: 10.1186/s13018-020-01925-x -
Factors Associated with Outpatient Satisfaction in Tertiary Hospitals in China: A Systematic Review.International Journal of Environmental... Sep 2020Outpatient care is made up of medical procedures, tests, and services that can be provided to the patient in a setting that doesn't involve an overnight hospital stay.... (Review)
Review
Outpatient care is made up of medical procedures, tests, and services that can be provided to the patient in a setting that doesn't involve an overnight hospital stay. In China, tertiary hospitals are medical services centers of health care systems, and some tertiary hospitals had more than 20,000 outpatient visits per day. However, a systematic review of existed evidence on factors influencing the outpatient satisfaction in tertiary hospitals in China could inform the efforts and does not yet exist. Therefore, in order to better understand the outpatient satisfaction provided by tertiary hospitals in China, we carried out a systematic review following PRISMA guidelines. Studies reporting on the level of and factors associated with outpatient satisfaction in Chinese tertiary hospitals were systematically searched in both Chinese and English electronic databases. A total of 36 articles reported 35 studies that met the inclusion criteria. Out of these eight were household surveys covering 12,119 residents, and another 27 directly interviewed 45,930 outpatients during their hospital visits from 185 hospitals. The included studies generally used self-designed questionnaire and indicated there is a lack of standardized questionnaire for investigating outpatient satisfaction in China. The outpatients showed the highest satisfaction with the doctors and nurses and the lowest satisfaction with the hospital hygiene and outpatient procedures, especially with the long waiting time. The socio-demographic characteristics (e.g., age, marital status, income and education levels), professional skills and service attitudes of medical staff were reported to be associated with outpatient satisfaction. The results indicated that in China, the outpatient satisfaction can be largely improved. Firstly, the attitude of medical service providers, especially the pre-diagnosis nurses, registration officers, and pharmaceutical counters should be improved. Furthermore, to shorten the waiting time, policies should be developed to guide patients with common diseases and slight discomforts to community health systems to alleviate the overload in tertiary hospitals. Considering the strained relations between the doctors and patients in the clinical practice, improving patient satisfaction in China deserves more attention and research.
Topics: China; Humans; Outpatients; Patient Satisfaction; Personal Satisfaction; Tertiary Care Centers
PubMed: 32992600
DOI: 10.3390/ijerph17197070 -
Neurology India 2016
Topics: Ambulatory Surgical Procedures; Brain Neoplasms; Humans; Neurosurgical Procedures; Outpatients
PubMed: 27625222
DOI: 10.4103/0028-3886.190283 -
Pediatrics Sep 2017
Topics: Anti-Bacterial Agents; Bacterial Infections; Hospitals; Humans; Outpatients; Vaccines
PubMed: 28808072
DOI: 10.1542/peds.2017-1695 -
BMJ Open Quality Mar 2021Increasing demand for outpatient appointments (OPA) is a global challenge for healthcare providers. Non-attendance rates are high, not least because of the challenges of...
Increasing demand for outpatient appointments (OPA) is a global challenge for healthcare providers. Non-attendance rates are high, not least because of the challenges of attending hospital OPAs due to transport difficulties, cost, poor health, caring and work responsibilities. Digital solutions may help ameliorate these challenges. This project aimed to implement codesigned outpatient video consultations across National Health Service (NHS) Highland using system-wide quality improvement approaches to implementation, involving patients, carers, clinical and non-clinical staff, national and local strategic leads. System mapping; an intensive codesign process involving extensive stakeholder engagement and real-time testing; Plan, Do, Study, Act cycles; and collection of clinician and patient feedback were used to optimise the service. Standardised processes were developed and implemented, which made video consulting easy to use for patients, embedded video into routine health service systems for clinicians and non-clinical staff, and automated much of the administrative burden. All clinicians and staff are using the system and both groups identified benefits in terms of travel time and costs saved. Transferable lessons for other services are identified, providing a practical blueprint for others to adapt and use in their own contexts to help implement and sustain video consultation services now and in the future.
Topics: Appointments and Schedules; Humans; Outpatients; Quality Improvement; Referral and Consultation; State Medicine
PubMed: 33674346
DOI: 10.1136/bmjoq-2020-001259 -
Family Practice Management 2022
Topics: Humans; Outpatients
PubMed: 35014779
DOI: No ID Found -
Journal of the American Heart... Nov 2018Background Acute infections are known cardiovascular disease ( CVD ) triggers, but little is known regarding how CVD risk varies following inpatient versus outpatient...
Background Acute infections are known cardiovascular disease ( CVD ) triggers, but little is known regarding how CVD risk varies following inpatient versus outpatient infections. We hypothesized that in- and outpatient infections are associated with CVD risk and that the association is stronger for inpatient infections. Methods and Results Coronary heart disease (CHD) and ischemic stroke cases were identified and adjudicated in the ARIC (Atherosclerosis Risk in Communities Study). Hospital discharge diagnosis codes and Medicare claims data were used to identify infections diagnosed in in- and outpatient settings. A case-crossover design and conditional logistic regression were used to compare in- and outpatient infections among CHD and ischemic stroke cases (14, 30, 42, and 90 days before the event) with corresponding control periods 1 and 2 years previously. A total of 1312 incident CHD cases and 727 incident stroke cases were analyzed. Inpatient infections (14-day odds ratio [ OR ]=12.83 [5.74, 28.68], 30-day OR =8.39 [4.92, 14.31], 42-day OR =6.24 [4.02, 9.67], and 90-day OR =4.48 [3.18, 6.33]) and outpatient infections (14-day OR =3.29 [2.50, 4.32], 30-day OR =2.69 [2.14, 3.37], 42-day OR =2.45 [1.97, 3.05], and 90-day OR =1.99 [1.64, 2.42]) were more common in all CHD case periods compared with control periods and inpatient infection was a stronger CHD trigger for all time periods ( P<0.05). Inpatient infection was also a stronger stroke trigger with the difference borderline statistically significant ( P<0.10) for the 42- and 90-day time periods. Conclusions In- and outpatient infections are associated with CVD risk. Patients with an inpatient infection may be at particularly elevated CVD risk and should be considered potential candidates for CVD prophylaxis.
Topics: Acute Disease; Aged; Cardiovascular Diseases; Case-Control Studies; Female; Humans; Infections; Inpatients; Logistic Models; Male; Odds Ratio; Outpatients; Risk Factors; Stroke; Time Factors
PubMed: 30571501
DOI: 10.1161/JAHA.118.009683 -
The American Journal of Managed Care May 2011To determine whether trends in psychological distress exist in the United States and whether trends in healthcare expenditures and outpatient visits were associated with...
OBJECTIVES
To determine whether trends in psychological distress exist in the United States and whether trends in healthcare expenditures and outpatient visits were associated with psychological distress.
STUDY DESIGN
Sequential cross-sectional study of nationally representative data.
METHODS
We examined data from the National Health Interview Survey (NHIS) from 1997 to 2004 linked to 2 years of subsequent Medical Expenditure Panel Survey (MEPS) data. Psychological distress was measured in the NHIS using the K6, a 6-item scale of the Kessler Psychological Distress Scale, which we classified as no/low, mild-moderate, or severe. We examined subsequent annualized total, outpatient, and office-based expenditures, and outpatient and office-based visits from MEPS.
RESULTS
Psychological distress remained stable from 1997 to 2004. There were upward trends in overall healthcare expenditures (P <.001) and outpatient expenditures (P <.001), but not outpatient visits. Overall healthcare expenditures, outpatient expenditures, and outpatient visits significantly increased as psychological distress increased from no/low to mild-moderate to severe. The interaction between psychological distress strata and year was not significant for expenditures or for visits.
CONCLUSIONS
The upward trend in total and outpatient healthcare expenditures in the United States appears unrelated to psychological distress, although healthcare expenditures are consistently higher among those with greater psychological distress. Future work will explore the impact of treatment on costs and stability of the nation's mental health over time.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Cross-Sectional Studies; Delivery of Health Care; Diagnostic and Statistical Manual of Mental Disorders; Female; Health Expenditures; Humans; Logistic Models; Male; Mental Health; Middle Aged; Office Visits; Outpatients; Population Surveillance; Psychiatric Status Rating Scales; Socioeconomic Factors; Stress, Psychological; United States; Young Adult
PubMed: 21718079
DOI: No ID Found -
Deutsches Arzteblatt International Apr 2016
Topics: Humans; Outpatients; Pain Measurement; Treatment Outcome
PubMed: 27146594
DOI: 10.3238/arztebl.2016.0250b