Outpatient clinic: where is the delay?

Patel, Hitesh; Luxman, C N; Bailey, Teresa; Brunning, J D M; Zemmel, D; Morrell, L K; Nathan, Miriam; Miller, Ron

doi:10.1258/jrsm.95.12.604

Cited by 14 publications

(9 citation statements)

References 3 publications

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“…The same clinic was re-evaluated in 2001 and, despite some changes in the clinic organisation, they still found that 41% of the consultant's time was spent away from the patient. 16 The mean consultation time had reduced from 8.2 minutes to 4.8 minutes. The most easily addressed inefficiency was time spent looking for missing information, mainly radiology reports.…”

Section: Running An Outpatient Servicementioning

confidence: 96%

Medical outpatients: changes that can benefit patients

Dunnill

Pounder

2004

Clinical Medicine

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-This article reviews the current literature relating to medical outpatient services. It has been produced as part of the RCP/NHS Confederation working party on outpatients departments. The article deals with surveys of patient views on outpatients, suggested ways of improving the service, and how best to accommodate teaching in this setting. An RCP booklet, 'How user friendly is your outpatient department?', has also been produced and is available from the college. KEY WORDS: ambulatory care, appointment, booking, clinic, outpatient, waiting timeMost physicians spend a significant part of their week working in the outpatient department but although the consultation in the outpatient clinic is an important part of patients' hospital care, it is traditionally an under-resourced area of the hospital. There has been little research into improving the service and, as a result, the experience for patients is not always as good as it should be.A well-run clinic will not only improve the experiences of patients but also the working lives of clinic staff. It may reduce the need for admission to hospital, both for disease control and for its investigation. 1 There is currently also political pressure for change, particularly regarding waiting times. The Government has recently issued a target of a maximum of three months wait for all outpatients' appointments by 2005. 2 This article reviews the literature relating to outpatients, with a focus on medical outpatients. The Working Party's aim was to develop recommendations to enable physicians to improve the experience for patients attending their clinics, and the work culminated in the publication of a booklet for health professionals. 3 Inevitably, in this paper there is some overlap with managerial issues (for example, direct booking systems or computer referral systems), and while some of these are beyond the scope of this article, they are addressed where physicians will be expected to work with managers to improve service delivery. Search strategyThe bibliographic databases Medline and Embase were searched for articles on outpatients, hospital outpatient clinics, outpatient departments or ambulatory care. Papers on day care were excluded. The results were limited to the UK, to the years 1966-2002 and to papers in English with abstracts available. Surveys of patient attitudes and satisfaction Waiting time and appointmentsLong waits for a first outpatient appointment are a common cause of patient dissatisfaction. However, one survey of a gastroenterology clinic showed that patients placed a similar value on waiting time for investigation and waiting for the first appointment: 4 a clinic that had a two-month wait for appointment, but offered immediate investigation was preferable to one with a two-week wait for appointment but a three-month wait for investigation. The authors suggest that to focus just on 'wait to first appointment' is too simplistic and does not take account of patient preferences.The length of time patients have to wait in the clinic before ...

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Section: Running An Outpatient Servicementioning

confidence: 96%

Medical outpatients: changes that can benefit patients

Dunnill

Pounder

2004

Clinical Medicine

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“…In 1988, the time spent with the patient in a urological outpatient clinic was 7.6 minutes on average. This decreased to 4.6 minutes in 2002 in spite of introducing time saving measures such as nurse-led clinics and one-stop clinics 40% was spent on administrative tasks [6]. In our own clinics before CRS, an average of 12 minutes total time per patient was scheduled.…”

Section: Discussionmentioning

confidence: 78%

“…To ease outpatient clinic pressures it was thought at the start of this millennium that an electronic patient data system might be the answer [6]. The Veteran Health Administration (VHA) in the USA had successfully introduced their Computerised Patient Record System (CPRS) and introduced it as a patient-centred approach to clinical computing rather than a department-centred approach [13].…”

Section: Discussionmentioning

confidence: 99%

“…The list of medical investigations and surgical treatments has increased dramatically, and patients are better informed, more demanding and expect more explanation, with doctors increasingly offering to share their knowledge [1,5]. Therefore, it was thought that perhaps an electronic system to access and record patient information may be the best approach to ease these pressures [6].…”

Section: Introductionmentioning

confidence: 99%

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The impact of a computerized care records service (CRS) on doctors’ work patterns in urological outpatient clinics

Kachrilas¹,

Bach²,

Kumar³

et al. 2011

Health

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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.

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“…Systems that provide patients with the ability to obtain their own results have been shown to be acceptable to patients and to save time among clinicians (Ridgeway et al 2000). Such a newly designed process should reduce the amount of time spent by clinic staff in information-gathering tasks and increase the time spent providing patient care (Patel et al 2002).…”

Section: Variancementioning

confidence: 99%

A macro-ergonomic work system analysis of the diagnostic testing process in an outpatient health care facility for process improvement and patient safety

2006

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The diagnosis of illness is important for quality patient care and patient safety and is greatly aided by diagnostic testing. For diagnostic tests, such as pathology and radiology, to positively impact patient care, the tests must be processed and the physician and patient must be notified of the results in a timely fashion. There are many steps in the diagnostic testing process, from ordering to result dissemination, where the process can break down and therefore delay patient care and reduce patient safety. This study was carried out to examine the diagnostic testing process (i.e. from ordering to result notification) and used a macro-ergonomic work system analysis to uncover system design flaws that contributed to delayed physician and patient notification of results. The study was carried out in a large urban outpatient health-care facility made up of 30 outpatient clinics. Results indicated a number of variances that contributed to delays, the majority of which occurred across the boundaries of different systems and were related to poor or absent feedback structures. Recommendations for improvements are discussed.

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Outpatient clinic: where is the delay?

Cited by 14 publications

References 3 publications

Medical outpatients: changes that can benefit patients

Medical outpatients: changes that can benefit patients

The impact of a computerized care records service (CRS) on doctors’ work patterns in urological outpatient clinics

A macro-ergonomic work system analysis of the diagnostic testing process in an outpatient health care facility for process improvement and patient safety

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