Integrating medical specialties and outpatient appointments - A novel pathway for multimorbid patients encountering several outpatient clinics

Purpose of the studyThe National Health Service is experiencing a recruitment crisis across many medical specialties. Diabetes and endocrinology (D&E) is failing to fill training posts with only 77%, 83% and 73% of posts filled overall in 2016, 2017 and 2018, respectively.Study designWe surveyed 316 final-year medical students and undifferentiated trainees (from foundation programme doctors to core medical trainees), across the South Thames, Northern and West Midlands deaneries in England to gain an understanding of perceptions of the specialty.Results9% of respondents were considering a career in D&E. Factors such as ‘being the medical registrar’ (27%), being a ‘non-procedural specialty’ (23%) and ‘looking after majority of general medical admissions’ (22%) were cited as the most common reasons why D&E is an unattractive career choice. 51% reported inadequate exposure to D&E. Factors that made respondents more likely to want to pursue a career in D&E included having undertaken a placement in the specialty and having exposure to outpatient clinics. Methods to improve awareness and uptake, such as increased teaching and clinical exposure, and the opportunity to attend taster events were frequently highlighted.ConclusionsThe results from this survey, the first of its kind on perceptions of D&E as a career pathway, reveal a worrying lack of interest in, and exposure to, D&E among current final-year medical students and undifferentiated trainees. These issues must be addressed in order to improve D&E recruitment rates.

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Non-attendance at psychiatric outpatient clinics: comparison of clinical, risk and demographic factors between attenders and non-attenders

BJPsych Open ◽

10.1192/bjo.2021.145 ◽

2021 ◽

Vol 7 (S1) ◽

pp. S35-S35

Author(s):

Mahum Kiani ◽

Nilamadhab Kar

Keyword(s):

Psychological Treatment ◽

Service Evaluation ◽

Outpatient Clinics ◽

Care Programme ◽

Clinical Risk ◽

Psychiatric Outpatient ◽

Significant Difference ◽

Depot Injections ◽

Outpatient Appointments ◽

Demographic Features

AimsWith an overarching aim of decreasing the incidence of non-attendance in psychiatric outpatient clinics, this service evaluation was intended to explore the profile of non-attenders. Specifically, the clinical, risk and demographic features of patients who did not attend their psychiatric outpatient appointments were compared with those of attenders. The outcome of patients who did not attend was also studied.MethodAll the consecutive non-attenders (n = 32) in November 2020 in a psychiatric outpatient clinic were compared with 32 consecutive attenders. The groups were compared based on clinical features (diagnosis, medical treatment, psychological treatment, care programme approach, first contact), risk profile (self or others) and demographic features (age, gender, ethnicity, accommodation, occupation, benefits). The non-attender sample was also analysed to consider the outcome after their missed appointment, following local Trust protocols.ResultThe overall rate of patients who did not attend their appointment was 22%. There was a statistically significant difference between the age and gender of non-attenders. Males were less likely to attend their appointment than females (p = 0.024). The mean age of patients who did not attend their appointment was 36.4 compared with 44.8 years in the attenders (p = 0.005). There were a few clinically relevant findings. Around one third (34%) of patients who did not attend their appointments had a history of risk of self-harm noted in previous appointments. The results also showed that 75% of individuals who did not attend their outpatient appointments were unemployed. There were no significant differences based on the type of treatments (depot injections, lithium, clozapine, antipsychotics or antidepressants) patients received. Patients who did not attend were more likely to have a mood disorder (59% compared with 40%), and less likely to have a psychotic disorder (25% compared with 44%). Of the patients who did not attend, all were appropriately contacted as per the local Trust guidelines via a letter, and were provided with appointments where appropriate; 34% of non-attenders were discharged from services.ConclusionNon-attendance at psychiatric outpatient appointments is a concern, particularly for younger and male patients. Considering the clinical risks associated with this patient population, efforts need to be taken to improve their engagement with mental health services. Future studies may explore patients’ perspectives of non-attendance and how to ameliorate any hindrances to attending.

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The Influence of Electronic Health Record Use on Collaboration Among Medical Specialties

10.21203/rs.3.rs-27832/v1 ◽

2020 ◽

Author(s):

Janita F.J. Vos ◽

Albert Boonstra ◽

Arjen Kooistra ◽

Marc Seelen ◽

Marjolein van Offenbeek

Keyword(s):

User Interfaces ◽

Clinical Decision Making ◽

Information Overload ◽

Collective Responsibility ◽

Clinical Decision ◽

Relevant Information ◽

Outpatient Clinics ◽

Structured Interviews ◽

Medical Specialties ◽

Mutual Awareness

Abstract Background:One of the main objectives ofElectronic Health Records (EHRs) is to enhancecollaboration among healthcare professionals. However, our knowledge of how EHRs actually affect collaborative practices is limited. This study examines how an EHR facilitates and constrains collaborationin five outpatient clinics.Methods: We conducted an embedded case study at five multidisciplinary outpatient clinics of a hospital that had implemented organization-wide EHR. Data were collected through semi-structured interviews with representatives of medical specialties, administration, nursing, and management. Documents were then analyzed to contextualize these data. We examined the following six collaborative affordances of EHRs: (1) portability, (2) co-located access, (3) shared overviews, (4) mutual awareness, (5) messaging, and (6) orchestrating.Results:Our findings demonstratehow an EHRwill simultaneously bothfacilitate andconstrain collaborationamong specialties and disciplines. Affordances that were inscribed in the system for collaboration purposeswere not fully actualized in the focal hospital because:(a)The EHR helps health professionalscoordinate patient care on an informed basis at any time and in any placebut only allows asynchronouspatient record use.(b)The comprehensive patient file affords joint clinical decision-making based on shared data, but specialty- and discipline-specific user-interfaces constrain mutual understanding of that data. Moreover, not all relevant information can be easily shared across specialties and outside the hospital.(c)The reduced necessity forface-to-face communication saves time but is experienced as hindering collective responsibility for a smooth workflow.(d)The EHR affords registration at the source and full registration of activities through orders, but the heightened administrative burdenfor physicians and the strict authorization rules on inputting dataconstrainthe flexible, multidisciplinary collaboration.(e) While the EHR affords a complete overview, information overload occurs due to the parallel generation of individually owned notes and the high frequency of asynchronous communication through messages of varying clinical priority.Conclusions: For the optimal actualization of EHRs’collaborative affordancesin hospitals, coordinated use of these affordancesby health professionalsis a prerequisite.Suchcoordinated userequires organizational, technical, and behavioral adaptations. Suggestions for hospital-wide policies toenhance trust in both the EHR and in its coordinated usefor effective collaboration are offered.

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The influence of Electronic Health Record use on collaboration among medical specialties

10.21203/rs.3.rs-27832/v2 ◽

2020 ◽

Author(s):

Janita F.J. Vos ◽

Albert Boonstra ◽

Arjen Kooistra ◽

Marc Seelen ◽

Marjolein A.G. van Offenbeek

Keyword(s):

User Interfaces ◽

Health Professionals ◽

Clinical Decision Making ◽

Collective Responsibility ◽

Relevant Information ◽

Outpatient Clinics ◽

Structured Interviews ◽

Dutch Hospital ◽

Medical Specialties ◽

Electronic Health

Abstract Background: One of the main objectives of Electronic Health Records (EHRs) is to enhance collaboration among healthcare professionals. However, our knowledge of how EHRs actually affect collaborative practices is limited. This study examines how an EHR facilitates and constrains collaboration in five outpatient clinics.Methods: We conducted an embedded case study at five multidisciplinary outpatient clinics of a Dutch hospital that had implemented an organization-wide EHR. Data were collected through semi-structured interviews with representatives of medical specialties, administration, nursing, and management. Documents were then analyzed to contextualize these data. We examined the following six collaborative affordances of EHRs: (1) portability, (2) co-located access, (3) shared overviews, (4) mutual awareness, (5) messaging, and (6) orchestrating.Results: Our findings demonstrate how an EHR will simultaneously both facilitate and constrain collaboration among specialties and disciplines. Affordances that were inscribed in the system for collaboration purposes were not fully actualized in the focal hospital because:(a) The EHR helps health professionals coordinate patient care on an informed basis at any time and in any place but only allows asynchronous patient record use. (b) The comprehensive patient file affords joint clinical decision-making based on shared data, but specialty- and discipline-specific user-interfaces constrain mutual understanding of that data. Moreover, not all relevant information can be easily shared across specialties and outside the hospital. (c) The reduced necessity for face-to-face communication saves time but is experienced as hindering collective responsibility for a smooth workflow. (d) The EHR affords registration at the source and full registration of activities through orders, but the heightened administrative burden for physicians and the strict authorization rules on inputting data constrain the flexible, multidisciplinary collaboration. (e) While the EHR affords a complete overview, information overload occurs due to the parallel generation of individually owned notes and the high frequency of asynchronous communication through messages of varying clinical priority.Conclusions: For the optimal actualization of EHRs’ collaborative affordances in hospitals, coordinated use of these affordances by health professionals is a prerequisite. Such coordinated use requires organizational, technical, and behavioral adaptations. Suggestions for hospital-wide policies to enhance trust in both the EHR and in its coordinated use for effective collaboration are offered.

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Multidisciplinary team decision is rare and decreasing in percutaneous vascular interventions despite positive impact on in-hospital outcomes

VASA ◽

10.1024/0301-1526/a000771 ◽

2019 ◽

Vol 48 (3) ◽

pp. 262-269 ◽

Cited By ~ 3

Author(s):

Christian-Alexander Behrendt ◽

Tilo Kölbel ◽

Thea Schwaneberg ◽

Holger Diener ◽

Ralf Hohnhold ◽

...

Keyword(s):

Multidisciplinary Team ◽

Positive Impact ◽

Cross Sectional Study ◽

Invasive Treatment ◽

Cross Sectional ◽

Hospital Outcomes ◽

Vascular Intervention ◽

Medical Specialties ◽

Team Decision ◽

The Impact

Abstract. Background: Worldwide prevalence of peripheral artery disease (PAD) is increasing and peripheral vascular intervention (PVI) has become the primary invasive treatment. There is evidence that multidisciplinary team decision-making (MTD) has an impact on in-hospital outcomes. This study aims to depict practice patterns and time changes regarding MTD of different medical specialties. Methods: This is a retrospective cross-sectional study design. 20,748 invasive, percutaneous PVI of PAD conducted in the metropolitan area of Hamburg (Germany) were consecutively collected between January 2004 and December 2014. Results: MTD prior to PVI was associated with lower odds of early unsuccessful termination of the procedures (Odds Ratio 0.662, p < 0.001). The proportion of MTD decreased over the study period (30.9 % until 2009 vs. 16.6 % from 2010, p < 0.001) while rates of critical limb-threatening ischemia (34.5 % vs. 42.1 %), patients´ age (70 vs. 72 years), PVI below-the-knee (BTK) (13.2 % vs. 22.4 %), and rates of severe TASC C/D lesions BTK (43.2 % vs. 54.2 %) increased (all p < 0.001). Utilization of MTD was different between medical specialties with lowest frequency in procedures performed by internists when compared to other medical specialties (7.1 % vs. 25.7 %, p < 0.001). Conclusions: MTD prior to PVI is associated with technical success of the procedure. Nonetheless, rates of MTD prior to PVI are decreasing during the study period. Future studies should address the impact of multidisciplinary vascular teams on long-term outcomes.

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A comparison of GP and GDS diagnosis of depression in late life among multimorbid patients – Results of the MultiCare Study

Das Gesundheitswesen ◽

10.1055/s-0034-1387020 ◽

2014 ◽

Vol 76 (08/09) ◽

Author(s):

M Schwarzbach ◽

M Luppa ◽

H Hansen ◽

HH König ◽

J Gensichen ◽

...

Keyword(s):

Late Life ◽

Multimorbid Patients

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The First Decade of Effort: Progress Toward a Hospital Information System at the UCLA Hospital, Los Angeles, California

Methods of Information in Medicine ◽

10.1055/s-0038-1636003 ◽

1970 ◽

Vol 09 (02) ◽

pp. 75-80

Author(s):

B. G. Lamson ◽

W. S. Russell ◽

J. Fullmore ◽

W. E. Nix

Keyword(s):

Los Angeles ◽

Medical Record ◽

Communication Systems ◽

The United States ◽

Computer Applications ◽

Record Management ◽

Successful Implementation ◽

Accounting System ◽

Accrual Accounting ◽

Medical Specialties

Total information and communication systems within hospitals have been designed, but successful complete implementation, to date, has not been achieved. Limited applications with both patient medical data, notably in the clinical laboratories, and in the hospital accounting offices have been numerous. Although total programs are not yet a reality, it is apparent that the computer will serve ultimately many communication requirements, both medical and financial, within the hospital.Sound hospital management requires that costs of all component operations be known in order that value judgments concerning worth and efficiency may be made. Accrual accounting systems which match revenue and expense over the same time period are a prerequisite. Cash and modified cash hospital accounting cannot provide current reliable data for sound decision making.Costs of hospital operations cannot be evaluated unless related to the characteristics of the patient service load. Average per diem costs mean little except when large similar populations of patients are being compared. A modern hospital accrual accounting system should be able to provide information concerning the costs of caring for specific diseases in patients with known age and sex and disease severity characteristics. Without information of this type, it will not be possible to objectively evaluate alternative systems of financing and organizing patient care.Medical record management offers the promise of prospective use of patient disease information in the planning and scheduling of facilities. The prose content of medical record summaries, such as diagnostic statements in tissue pathology, radiology, and admission and discharge diagnoses, may be susceptible to non-coded, full prose input into computer controlled diagnostic files. Thesauri in the several medical specialties will be necessary for this achievement.There is little immediate prospect for complete hospital communication systems that can be made available as a package to any hospital without substantial local alteration. Pilot projects in teaching centers should be viewed for the time being as opportunities to define objectives, evaluate feasibility, and determine degree of risk and expense.A brief survey of applications in the United States which have been successfully implemented or which appear suitable for successful implementation is recorded.Eleven general principles which have been associated with successful implementation of computer applications within the UCLA Hospital are enumerated.

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