Objective: Government targets to reduce waiting times are putting enormous pressures on outpatient services. The implementation of an electronic care records service (CRS) at our hospital in 2008 has led to widespread press coverage of ensuing chaos in clinical administration. We wanted to know how this new electronic system impacted on our working patterns in outpatient clinics and-more specifically-on the time actually spent with the patients. Material & methods: This study was performed 4 and 12 months after implementation of CRS to assess its impact on the time distribution in clinic. Senior doctors were monitored with a stop clock during consultations. Timings for pre-and post-consultation administration, and the actual consultation with the patient were recorded. A total of 170 consultations were evaluated in this way. Results: The key findings were that the total time needed to spend on a urological outpatient of 16 minutes remains unchanged from the pre-CRS era, but a majority (57%) of this time is spent in administration on the computer without the patient involved. Conclusion: No more than 15 patients should be seen in a 4 hour outpatient clinic per doctor. This recommendation drawn up by BAUS before CRS remains still valid. Patient administration related to the consultation that has previously been done by administrative aides is now to be done by the doctors on the computer in the same consultation session. Intended to streamline patient pathways, this does reduce the quality interaction-time between doctor and patients significantly.

Polypharmacy, defined as consumption of 5 or more medications on a long term basis, has become increasingly prevalent, especially in the elderly population. Medications include prescription and over-the-counter medications as well as vitamins and herbal supplements taken on a weekly or daily basis. The charts of patients attending a large urban clinic in a metropolitan area in the southeast U.S. were reviewed to identify the prevalence of polypharmacy. Out of the 1123 charts of patients age 65 or over, 320 charts (107 male, 212 female) were randomly selected and considered eligible for the study. Fifty-one percent of the patients were African-American, 40% were Caucasian. Only those medical records that occurred within a one-year period from the date of the last clinic visit were used to gather the following information: patient's demographics, medical history, and medication record. Complete information was obtained on 290 patients and used in the statistical analysis of the data. Forty-nine percent of our patient population was on polypharmacy. Significant predictors of polypharmacy included the number of diagnoses, such as hypertension and diabetes, and patient gender. Women took significantly more pills than men (F = 17.217, p < .0005, women = 6.03, men = 4.74). As this pilot study shows, polypharmacy is common among seniors. Our findings suggest that further studies should be conducted to determine the predictors of polypharmacy in a geriatric population. Likewise, future intervention studies are needed to reduce inappropriate medication use, allowing a decrease in likeliness of adverse drug events and lowering health care costs.

On the other hand, the flow crossmatch was positive in sixteen percent of those who had functioning renal grafts. Conclusion: Although these numbers are small, the data suggest that positive flow cytometry crossmatches are related to lower renal allograft survival rates at our center. Further studies will be performed on a larger patient population.