Surgical outpatient clinics: are we allowing enough time?
BACKGROUND: Performance management initiatives, such as the UK's Patient's Charter, are creating pressure for patients to be seen earlier at out patient clinics, thus increasing clinic workloads. There is, however, little information about whether this can be absorbed, either by utilizing spare capacity or by more efficient use of time, or whether it is likely to affect patient care adversely. METHODS: Nine surgical clinics, run by four general surgeons, in an English district general hospital were studied during a typical week. Clinic schedules and numbers invited to attend were extracted from clinic records. An observer recorded the actual time each patient spent with the surgeon to the nearest 5 seconds. Scheduled and actual times of commencement and completion of clinics were also recorded. RESULTS: The number of patients booked to attend each clinic varied from 11 to 82 (mean 37). The median consultation for new patients was 4.3 minutes and for follow-up patients it was 3 minutes. Consultants spent a median 2.7 minutes with patients whereas junior staff spent 4.2 minutes. These aggregate results conceal considerable variation between surgeons, even though the scheduled time available was similar. The median time spent with new patients by one consultant was 1.3 minutes and by another 13.1 minutes. Seven of the nine clinics overran their scheduled time (by up to 55 minutes). All doctors, with one exception, arrived late for the clinics (range 10 minutes early to 30 minutes late). The first patient was invariably seen after the scheduled starting time for the clinic (mean 17 minutes, range 5-50 minutes) and the median interval between a doctor arriving and seeing their first patient was 10.6 minutes. Overall, only 50% of the time spent by doctors at the clinics was with patients. IMPLICATIONS: The amount of time spent by patients with surgeons is already so short as to cause concern about both the appropriateness and value of consultations. It is unreasonable to increase workload further. There is a clear need for outpatient clinics to be managed, with regular examination of what is taking place and how long it takes. Only then will it be possible to tailor schedules to the actual requirements of the service. (+info)
Workflow analysis and evidence-based medicine: towards integration of knowledge-based functions in hospital information systems.
The large extent and complexity of scientific evidence described in the concept of evidence-based medicine often overwhelms clinicians who want to apply best external evidence. Hospital Information Systems usually do not provide knowledge-based functions to support context-sensitive linking to external information sources. Knowledge-based components need specific data, which must be entered manually and should be well adapted to clinical environment to be accepted by clinicians. This paper describes a workflow-based approach to understand and visualize clinical reality as a preliminary to designing software applications, and possible starting points for further software development. (+info)
Medicare and Medicaid programs; hospital Conditions of Participation: anesthesia services. Final rule.
This final rule amends the Anesthesia Services Condition of Participation (CoP) for hospitals, the Surgical Services Condition of Participation for Critical Access Hospitals (CAH), and the Surgical Services Condition of Coverage for Ambulatory Surgical Centers (ASCs), and, with its publication, withdraws the January 18, 2001 final rule (66 FR 4674).This final rule maintains the current physician supervision requirement for certified registered nurse anesthetists(CRNAs), unless the Governor of a State, in consultation with the State's Boards of Medicine and Nursing, exercises the option of exemption from this requirement consistent with State law. (+info)
Impact of questionnaires and telephone screening on attendance for ambulatory surgery.
The purpose of this study was to determine whether patient questionnaires along with pre-operative telephone screening could help to reduce the number of cancellations or postponements of patients listed for day case endoscopy and local anaesthetic procedures and thereby provide cost effective and more efficient patient care management. A total of 566 questionnaires were sent out with a return figure of 477 (84.27%). Of those not returning the questionnaires, 56 (9.89%) were contacted by telephone giving an overall figure of 533 (94.16%) patients contacted. The cancellation rate for this group was only 2.25% compared to figures between 8-12% as noticed in the previous year. We conclude questionnaires along with telephone screening are a very effective tool in reducing cancellations and postponements of day case patients. (+info)
The effect of physician-owned surgicenters on hospital outpatient surgery.
Hospitals increasingly find themselves subject to competition from freestanding outpatient treatment facilities such as diagnostic imaging centers and ambulatory surgery centers. That competition causes hospitals particularly intense concern when the freestanding facility is owned by physicians who are on the hospital's medical staff. We find some basis for that concern. Further, this particular form of rivalry raises competitive complications that differentiate it from the standard antitrust analysis of new competitive entry. (+info)
The community hospital as a focus for health planning.
A community hospital focus for health planning has been developed by a Department of Community Medicine in a "non-teaching" voluntary hospital. Results of three years of planning experience have included: descriptions of service area populations and utilizer populations; implementation of neighborhood based health centers with transportation and outreach programs; integration of emergency services with other ambulatory care resources; and proposals for geriatric day-care, ambulatory surgery, and patient education. Working relationships have been developed between the hospital Department and local planning bodies, among them the Comprehensive Health Planning agency, the County Health Services Department, consumer groups, voluntary agencies and a University Health Services Center. (+info)
Using data from Round Four of the Community Tracking Study site visits, this paper describes the recent rapid increase in physician-owned specialty hospitals and ambulatory surgery centers, reasons for this increase, possible impacts, and potential policy options. These facilities could lead to excess capacity, provision of unnecessary services, and lower quality because of decreased volume at some facilities. They also could reduce community hospitals' net revenue and thus their ability to subsidize socially necessary but unprofitable services. But regulatory intervention should be cautious, because data on impact are inconclusive, and these facilities could have the potential to function as "focused factories" that improve quality and reduce costs. (+info)
Comparing the mix of patients in various outpatient surgery settings.
Medicare's facility payment rates for an ambulatory surgical procedure differ among settings. These differences raise questions about how Medicare should pay for the same procedure in various settings. In exploring this issue, it is important to look at whether the type of patients treated varies by setting. The recent growth in specialty facilities offers another reason to analyze the mix of patients. This study compares the medical complexity of Medicare beneficiaries treated in ambulatory surgical centers (ASCs) and outpatient departments. Outpatient departments treat beneficiaries who are more medically complex, so ASCs might incur lower costs when providing similar procedures. (+info)