Patient Flow Analysis in General Hospitals: How Clinical Disciplines Affect Outpatient Wait Times

Background: Overcrowding is an important problem for outpatient services in healthcare facilities. Patient flow analysis (PFA) is a useful method for identifying inefficiencies in and facilitating patient flow. Objective: PFA was used to estimate patient wait time and determine how different clinical disciplines impact wait times in the studied hospital. Methods: This cross-sectional study investigated a study population comprised of outpatients who referred to clinics at a general hospital in Tehran, Iran. A total of 3836 samples were selected from different stations. Nonrandomized quota sampling was used, and data was gathered using workflow checklists, the content validity of which was proven by experts and hospital authorities. SPSS statistical software was used for data analysis. Results: Total patient stay in the outpatient setting was an estimated 77 minutes (without considering para-clinic units and pharmacy). More than 90% of this time was spent waiting. The wait time of patients at the clinic was greater than that at other stations, and it was less at the cash station than at other stations. Wait times varied at different clinics (P value < 0.001) and were correlated with physician delay (P value < 0.001). Conclusion: The most important result of using PFA in the outpatient setting was managing wait times. This study indicated that a considerable amount of a patient’s total stay in the system was related to waiting for physical examinations. This suggests that the first priority in improving the system should be managing patient wait times for physical examinations.

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Why Don't Patients Referred by a Family PhysicianVisit a Specialist? A Study in Golestan Province in Northern Iran

10.21203/rs.3.rs-35954/v1 ◽

2020 ◽

Author(s):

Mohammad Javad Kabir ◽

Hamid Pourasghari ◽

Alireza Heidari ◽

Zahra Khatirnamani ◽

Sakine Beygom Kazemi ◽

...

Keyword(s):

Significant Relationship ◽

Age Groups ◽

Cross Sectional Study ◽

Average Score ◽

Wait Times ◽

Outpatient Services ◽

Validity And Reliability ◽

Northern Iran ◽

Cross Sectional ◽

And Gender

Abstract Background Utilizing electronic referral (eReferral) system while enhancing the efficiency and quality of medical services may improve the access level to specialized services and reduce patients' wait times; however, some patients do not follow the the eReferral system guidelines. The present study aims at figuring out why outpatients referred by family physicians to specialists do not visit specialists. Methods The present cross-sectional study was conducted in the hospitals wherein eReferral system was implemented as a pilot plan in the calendar year started on 21 March 2019. The sampling was done in two phases: 1) proportionate stratified sampling method, and 2) systematic random sampling. The first, 429 patients were selected. These patients were referred by a rural family physician (FP) to a specialist in the district hospital, but despite appointment made for them by the relevant FP, they had not visited specialists. Then, data was collected using a self-made questionnaire whose validity and reliability were confirmed (α = 0.90). Descriptive statistical methods were used to describe the data and analytical methods, i.e. Spearman, Mann-Whitney and Croscal Wallis correlation tests were also conducted. Data analysis was performed using SPSS 16 at a significant level of 0.05. Findings : Most of the participants (54.7%) were female, 43.4% were in the age group of 30–60, 81.6% were married, 26.4% had high school diploma, 47.2% were housewives, 81.6% were rural residents. Among the dimensions of the reasons why patients did not visit specialists, the clinic conditions (3.26 ± 0.74), side expenditures (2.51 ± 0.74), admission and queuing system (2.45 ± 0.70) accounted for the highest average score, respectively. There was significant relationship between age groups, marital status, level of education, occupation, place of residence and type of insurance (p < 0.05), but no significant relationship was observed between them and gender (p > 0.05). Conclusion Reducing patient wait times in the clinic, providing patients with appropriate guidance, enhancing patients’ freedom to determine the time to visit specialists, training physicians to communicate with patients properly, reassuring and reducing costs were of great importance to encourage receiving outpatient services within the framework of eReferral system.

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Infection control practices and challenges in Pakistan during the COVID-19 pandemic: a multicentre cross-sectional study

Journal of Infection Prevention ◽

10.1177/17571774211012761 ◽

2021 ◽

pp. 175717742110127

Author(s):

Salma Abbas ◽

Faisal Sultan

Keyword(s):

Personal Protective Equipment ◽

Prevention And Control ◽

Infection Prevention ◽

Hospital Staff ◽

Cross Sectional Study ◽

Infection Prevention And Control ◽

Protective Equipment ◽

Cross Sectional ◽

Healthcare Facilities ◽

And Control

Background: Patient and staff safety at healthcare facilities during outbreaks hinges on a prompt infection prevention and control response. Physicians leading these programmes have encountered numerous obstacles during the pandemic. Aim/objective: The aim of this study was to evaluate infection prevention and control practices and explore the challenges in Pakistan during the coronavirus disease 2019 pandemic. Methods: We conducted a cross-sectional study and administered a survey to physicians leading infection prevention and control programmes at 18 hospitals in Pakistan. Results: All participants implemented universal masking, limited the intake of patients and designated separate triage areas, wards and intensive care units for coronavirus disease 2019 patients at their hospitals. Eleven (61%) physicians reported personal protective equipment shortages. Staff at three (17%) hospitals worked without the appropriate personal protective equipment due to limited supplies. All participants felt overworked and 17 (94%) reported stress. Physicians identified the lack of negative pressure rooms, fear and anxiety among hospital staff, rapidly evolving guidelines, personal protective equipment shortages and opposition from hospital staff regarding the choice of recommended personal protective equipment as major challenges during the pandemic. Discussion: The results of this study highlight the challenges faced by physicians leading infection prevention and control programmes in Pakistan. It is essential to support infection prevention and control personnel and bridge the identified gaps to ensure patient and staff safety at healthcare facilities.

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Socioeconomic determinants of unmet need for outpatient healthcare services in Iran: a national cross-sectional study

BMC Public Health ◽

10.1186/s12889-021-10477-6 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Sajad Vahedi ◽

Amin Torabipour ◽

Amirhossein Takian ◽

Saeed Mohammadpur ◽

Alireza Olyaeemanesh ◽

...

Keyword(s):

Health System ◽

Age Groups ◽

Unmet Need ◽

Healthcare Services ◽

Cross Sectional Study ◽

Outpatient Services ◽

Self Medication ◽

Cross Sectional ◽

Organizational Policies ◽

Utilization Of Healthcare

Abstract Background Unmet need is a critical indicator of access to healthcare services. Despite concrete evidence about unmet need in Iran’s health system, no recent evidence of this negative outcome is available. This study aimed to measure the subjective unmet need (SUN), the factors associated with it and various reasons behind it in Iran. Methods We used the data of 13,005 respondents over the age of 15 from the Iranian Utilization of Healthcare Services Survey in 2016. SUN was defined as citizens whose needs were not sought through formal healthcare services, while they did not show a history of self-medication. The reasons for SUN were categorized into availability, accessibility, responsibility and acceptability of the health system. The multivariable logistic regression was used to determine significant predictors of SUN and associated major reasons. Results About 17% of the respondents (N = 2217) had unmet need for outpatient services. Nearly 40% of the respondents chose only accessibility, 4% selected only availability, 78% chose only responsibility, and 13% selected only acceptability as the main reasons for their unmet need. Higher outpatient needs was the only factor that significantly increased SUN, responsibility-related SUN and acceptability-related SUN. Low education was associated with higher SUN and responsibility-related SUN, while it could also reduce acceptability-related SUN. While SUN and responsibility-related SUN were prevalent among lower economic quintiles, having a complementary insurance was associated with decreased SUN and responsibility-related SUN. The people with basic insurance had lower chances to face with responsibility-related SUN, while employed individuals were at risk to experience SUN. Although the middle-aged group had higher odds to experience SUN, the responsibility-related SUN were prevalent among elderly, while higher age groups had significant chance to be exposed to acceptability-related SUN. Conclusion It seems that Iran is still suffering from unmet need for outpatient services, most of which emerges from its health system performance. The majority of the unmet health needs could be addressed through improving financial as well as organizational policies. Special attention is needed to address the unmet need among individuals with poor health status.

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Obesity, Blood Pressure, and Intraocular Pressure: A Cross-Sectional Study in Italian Children

Obesity Facts ◽

10.1159/000514096 ◽

2021 ◽

pp. 1-9

Author(s):

Claudia Pileggi ◽

Rosa Papadopoli ◽

Caterina De Sarro ◽

Carmelo Giuseppe Angelo Nobile ◽

Maria Pavia

Keyword(s):

Blood Pressure ◽

Intraocular Pressure ◽

School Children ◽

Adult Population ◽

Paediatric Population ◽

Cross Sectional Study ◽

Cross Sectional ◽

Drinking Habits ◽

Physical Examinations ◽

Italian Children

Introduction: Several studies in the adult population have shown that obesity is an independent risk factor for elevated intraocular pressure (IOP), whereas data in the paediatric population are sparse and controversial. The purpose of the present study is to investigate the relationship between body mass index (BMI), blood pressure (BP), and IOP in healthy school children. Methods: The survey was conducted among a random sample of 8-year-old Italian students. Data were collected on their health status and behaviours related to obesity (physical activity, food and drinking habits, etc.). Physical examinations, conducted at school, included measurements of height, weight, BP, and IOP. Results: Five hundred and seventy-six subjects were recruited (92.8% response rate); 42.4% were overweight or obese, 58.9% consumed inadequate daily servings of fruit and vegetables, and 87.5% were involved in sedentary activities. Elevated BP/hypertension (HTN) affected 3.6% and high IOP was revealed in 12.5% of the children. In the multivariate analysis, elevated BP/HTN was the only significant determinant of ocular HTN (OR 5.36, 95% CI 1.95–14.73, p = 0.001). Conclusions: Our results show that high IOP affects 12.5% of 8-year-old school children and appears to be associated with high BP related to a high BMI.

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Assessing the Preparedness of Healthcare Facilities for Disasters and Emergencies in Damghan, Iran

Disaster Medicine and Public Health Preparedness ◽

10.1017/dmp.2021.104 ◽

2021 ◽

pp. 1-7

Author(s):

Behrad Pourmohammadi ◽

Ahad Heydari ◽

Farin Fatemi ◽

Ali Modarresi

Keyword(s):

Health Care ◽

Cross Sectional Study ◽

Health Care Facilities ◽

Mitigation Measures ◽

Health Staff ◽

Cross Sectional ◽

Healthcare Facilities ◽

Wide Range ◽

Care Facilities ◽

The Impact

Abstract Objectives: Iran is exposed to a wide range of natural and man-made hazards. Health-care facilities can play a significant role in providing life-saving measures in the minutes and hours immediately following the impact or exposure. The aim of this study was to determine the preparedness of health-care facilities in disasters and emergencies. Methods: This cross-sectional study was conducted in Damghan, Semnan Province, in 2019. The samples consisted of all the 11 health-care facilities located in Damghan County. A developed checklist was used to collect the data, including 272 questions in 4 sections: understanding threatening hazards, functional, structural, and nonstructural vulnerability of health-care facilities. The data were analyzed using SPSS 21. Results: The results revealed that the health-care facilities were exposed to 22 different natural and man-made hazards throughout the county. The total level of preparedness of the health-care centers under assessment was 45.8%. The average functional, structural, and nonstructural vulnerability was assessed at 49.3%, 31.6%, and 56.4%, respectively. Conclusions: Conducting mitigation measures is necessary for promoting the functional and structural preparedness. Disaster educational programs and exercises are recommended among the health staff in health-care facilities.

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An assessment of the quality indicators of operative and non-operative times in a public university hospital

Einstein (São Paulo) ◽

10.1590/s1679-45082015gs3289 ◽

2015 ◽

Vol 13 (4) ◽

pp. 594-599 ◽

Cited By ~ 5

Author(s):

Altair da Silva Costa Jr ◽

Luiz Eduardo Villaça Leão ◽

Maykon Anderson Pires de Novais ◽

Paola Zucchi

Keyword(s):

Standard Deviation ◽

Operating Room ◽

Operative Time ◽

Patient Flow ◽

Cross Sectional Study ◽

Public University ◽

Major Effect ◽

University Hospital ◽

Cross Sectional ◽

Using Data

ABSTRACT Objective To assess the operative time indicators in a public university hospital. Methods A descriptive cross-sectional study was conducted using data from operating room database. The sample was obtained from January 2011 to January 2012. The operations performed in sequence in the same operating room, between 7:00 am and 5:00 pm, elective or emergency, were included. The procedures with incomplete data in the system were excluded, as well as the operations performed after 5:00 pm or on weekends or holidays. Results We measured the operative and non-operative time of 8,420 operations. The operative time (mean and standard deviation) of anesthesias and operations were 177.6±110 and 129.8±97.1 minutes, respectively. The total time of the patient in operative room (mean and standard deviation) was 196.8±113.2. The non-operative time, e.g., between the arrival of the patient and the onset of anesthesia was 14.3±17.3 minutes. The time to set the next patient in operating room was 119.8±79.6 minutes. Our total non-operative time was 155 minutes. Conclusion Delays frequently occurred in our operating room and had a major effect on patient flow and resource utilization. The non-operative time was longer than the operative time. It is possible to increase the operating room capacity by management and training of the professionals involved. The indicators provided a tool to improve operating room efficiency.

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Baseline assessment of therapeutic injection practices in Pakistan in 2020: a cross-sectional study

Journal of the Pakistan Medical Association ◽

10.47391/jpma.0003 ◽

2021 ◽

pp. 16-21

Author(s):

Syed Sharaf Ali Shah ◽

Safdar Pasha ◽

Nikhat Iftikar ◽

Altaf Ahmed Soomro ◽

Nazia Farrukh ◽

...

Keyword(s):

Public Sector ◽

Healthcare Providers ◽

Cross Sectional Study ◽

Health Facilities ◽

Cross Sectional ◽

Injection Equipment ◽

Public And Private ◽

Healthcare Facilities ◽

The Public ◽

Injection Safety

Objective: To assess the magnitude of the problem of injection safety in public and private health facilities in two districts of Sindh and Punjab provinces of Pakistan. Methods: A cross-sectional observational study was conducted between October and December 2020 among public and private health facilities of two districts of Pakistan: Gujarat in Punjab and Larkana in Sindh provinces. A convenient sample size of 60 healthcare facilities (30 from each district) was taken due to time and resource constraint. Six data collection tools were used which included structured observations and interviews with injection prescribers and providers based on WHO Revised Tool C, which were finalised after piloting. Results: Reuse of injection equipment was not observed in any of the 60 health facilities. In exit interviews of 120 patients, it was found that 27 (22.5%) patients reported receiving an injection, while 11 (9.2%) were prescribed intravenous (IV) drips. More injections and drips were prescribed in the private sector (n=15; 25.0%) in comparison with the public sector (n=12; 20.0%). Slightly higher proportion of IV drips were prescribed by the private providers when compared to public sector healthcare providers: 6 (10.0%) vs 5 (8.3%) respectively. Most of the prescribers (n=58; 96.7%) reported that patients who attended public and private health facilities demanded injectable medicines. Used syringes and drips were noted to be visible in open containers and buckets for final disposal in 20 (33.3%) assessed health facilities. Continuou...

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Improving patient flow and timeliness in the diagnosis and management of breast abnormalities: the impact of a rapid diagnostic unit

Current Oncology ◽

10.3747/co.23.3017 ◽

2016 ◽

Vol 23 (3) ◽

pp. 260 ◽

Cited By ~ 8

Author(s):

J.M. Racz ◽

C.M.B. Holloway ◽

W. Huang ◽

N.J. Look Hong

Keyword(s):

Care Delivery ◽

Patient Flow ◽

Wait Time ◽

Definitive Treatment ◽

Wait Times ◽

Fisher Exact Test ◽

Patient Anxiety ◽

Diagnostic Unit ◽

Clinical Investigations ◽

The Impact

Background Efforts to streamline the diagnosis and treatment of breast abnormalities are necessary to limit patient anxiety and expedite care. In the present study, we examined the effect of a rapid diagnostic unit (RDU) on wait times to clinical investigations and definitive treatment.Methods A retrospective before–after series, each considering a 1-year period, examined consecutive patients with suspicious breast lesions before and after initiation of the RDU. Patient consultations, clinical investigations, and lesion characteristics were captured from time of patient referral to initiation of definitive treatment. Outcomes included time (days) to clinical investigations, to delivery of diagnosis, and to management. Groups were compared using the Fisher exact test or Student t-test.Results The non-RDU group included 287 patients with 164 invasive breast carcinomas. The RDU group included 260 patients with 154 invasive carcinomas. The RDU patients had more single visits for biopsy (92% RDU vs. 78% non-RDU, p < 0.0001). The RDU group also had a significantly shorter wait time from initial consultation to delivery of diagnosis (mean: 2.1 days vs. 16.7 days, p = 0.0001) and a greater chance of receiving neoadjuvant chemotherapy (37% vs. 24%, p = 0.0106). Overall time from referral to management remained statistically unchanged (mean: 53 days with the RDU vs. 50 days without the RDU, p = 0.3806).Conclusions Introduction of a RDU appears to reduce wait times to definitive diagnosis, but not to treatment initiation, suggesting that obstacles to care delivery can occur at several points along the diagnostic trajectory. Multipronged efforts to reduce system-related delays to definitive treatment are needed.

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HemoCue against Coulter LH-750 in the estimation of hemoglobin levels of blood donors in mobile collection settings: a comparative study

Medical Journal of Indonesia ◽

10.13181/mji.v27i4.2635 ◽

2018 ◽

Vol 27 (4) ◽

pp. 250-5

Author(s):

Sultan A.M. Saghir ◽

Amer A. Almaiman ◽

Aishah K.A. Shatar ◽

Norris Naim ◽

Huda S. Baqir

Keyword(s):

Blood Donors ◽

Reference Method ◽

Cross Sectional Study ◽

Outpatient Setting ◽

Concordance Correlation ◽

Cross Sectional ◽

New Device ◽

Coefficients Of Variation ◽

Significant Difference

Background: The fast and outpatient setting for a determination of the hemoglobin (Hb) level is a well-recognized prerequisite to detect anemia in blood donors. This study aimed to evaluate the performance of the HemoCue methods (HemoCue B-Hb and HemoCue-301) against Coulter LH-750 as a reference method for Hb determination.Methods: This study was an experimental cross-sectional study. It includes 455 blood samples that were collected from volunteer blood donors between January 15, 2010 and February 15, 2011. The performance of the three methods and their comparisons were assessed using the analysis of coefficients of variation (CV), linear regression, and mean difference. Correlation coefficient and Bland–Altman plots were drawn to compare the two HemoCue measurements and the automated cell analyzer against each other and to evaluate their results. The Hb concentrations were compared using the concordance correlation coefficient.Results: The findings exhibited that the CV for the three methods Coulter LH-750, HemoCue B-Hb, and HemoCue-301 were 0.60%, 0.72%, and 0.92%, respectively. A statistically significant difference was observed between the means of the Hb measurements for the three methods (p<0.001). The HemoCue B-Hb and HemoCue-301 methods showed the best agreement, and the Coulter LH-750 method gave a lower Hb value compared with the two HemoCue methods. The results showed a positive correlation of HemoCue Hb results compared with the reference method.Conclusion: All three methods provide a good agreement for Hb determination. The new device HemoCue-301 was found to be more accurate compared with HemoCue B-Hb and Coulter LH-750.

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Knowledge, Attitudes, and Practice Related to COVID-19 Among Healthcare Workers in the United Arab Emirates: A Cross-sectional Study.

10.21203/rs.3.rs-770359/v1 ◽

2021 ◽

Author(s):

Amina M. Al Marzouqi ◽

Michael E. Otim ◽

Heba H. Hijazi ◽

Leena S. Kehail ◽

Ramsha A. Kamal

Keyword(s):

United Arab Emirates ◽

Healthcare Workers ◽

Cross Sectional Study ◽

Snowball Sampling ◽

Sectional Study ◽

Online Questionnaire ◽

Cross Sectional ◽

Healthcare Facilities ◽

Attitudes And Practices ◽

Knowledge Attitudes And Practices

Abstract Objectives: The coronavirus disease-2019 (COVID-19) outbreak is a global health pandemic that continues to have an impact on many aspects of everyday life. This study investigates the Knowledge, Attitudes, and Practices (KAP) related to COVID-19 among healthcare workers in the United Arab Emirates (UAE). Methods: This study uses a cross-sectional study design. The original data were collected using an online questionnaire distributed via a Google Forms link. Participants were healthcare workers currently working in the UAE healthcare facilities and recruited using snowball sampling. The questionnaire collected information on demographic variables and COVID-19-related knowledge, attitudes, and practice.Results: In total, the sample of 107 healthcare workers completed the survey. About 92% of the participants worked in public institutions, 87% were from Dubai, and 673% were female. The majority were aged 31–40 years (34.6%), and 43% were radiographers. 66.4% held bachelor’s degrees and Indian nationalities were (28%) and the Philippinos were (28%). Most (90.7%) participants knew the absence of fever did not mean that the virus could not transmit from an infected person, and 84.1% agreed that wearing general medical masks prevented one from contracting COVID-19. However, only 36.4% strongly believed that wearing a well-fitting face mask was effective. In addition, only 15.9% reported confidently managing patients with symptoms of COVID-19, and 54.2% reported that they were afraid of contracting the virus from patients. Almost half of the participants avoided patients who had symptoms of COVID-19. Conclusion: Overall, healthcare workers’ COVID-19-related knowledge, attitudes, and practices for healthcare workers in UAE healthcare facilities was very high. However, we found gaps in awareness regarding the spread of the pandemic. Our study recommends that providing healthcare workers with education programs and counseling services would help increase their confidence in treating patients with COVID-19.

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