Home care of high risk pregnant women by advanced practice nurses: nurse time consumed.
This study examined the time spent by advanced practice nurses (APNs) in providing prenatal care to women with high risk pregnancies. The results indicate that the overall mean APN time spent in providing prenatal care was 51.3 hours per woman. The greatest amount of time was spent in the clinic and women with pregestational diabetes consumed the most APN time and required the most contacts. Historically, home care services have been measured by number of visits or contacts. This study assists home care nurses and administrators to consider additional measurements including time spent. (+info)
Audit of thrombolysis initiated in an accident and emergency department.
Early thrombolytic therapy after acute myocardial infarction is important in reducing mortality. To evaluate a system for reducing in-hospital delays to thrombolysis pain to needle and door to needle times to thrombolysis were audited in a major accident and emergency (A and E) department of a district general hospital and its coronary care unit (CCU), situated about 5 km away. Baseline performance over six months was assessed retrospectively from notes of 43 consecutive patients (group 1) transferred to the CCU before receiving thrombolysis. Subsequently, selected patients (23) were allowed to receive thrombolysis in the A and E department before transfer to the CCU. The agent was administered by medical staff in the department after receiving oral confirmation of myocardial infarction from the admitting medical officer in the CCU on receipt of fax transmission of the electrocardiogram. A second prospective audit during six months from the start of the new procedure established time intervals in 23 patients eligible to receive thrombolysis in the A and E department (group 2b) and 30 ineligible patients who received thrombolysis in the CCU (group 2a). The groups did not differ significantly in case mix, pre-hospital delay, or transfer time to the CCU. In group 2b door to needle time and pain to needle time were reduced significantly (geometric mean 38 min v 121 min (group 2a) and 128 min (group 1); 141 min v 237 min (group 2a) and 242 min (group 1) respectively, both p < 0.0001). The incidence of adverse effects was not significantly different. Nine deaths occurred (six in group 1, three in group 2b), an in-hospital mortality of 9.9%. Thrombolysis can be safely instituted in the A and E department in selected patients, significantly reducing delay to treatment. (+info)
Quality: link with effectiveness.
In summary, though the notion of "quality of care" has become fashionable, most of the focus has been on initiatives such as the patient's charter, waiting times, quality of the physical environment, patient centredness in outcomes measurement, etc. Nevertheless, at the heart of quality must be the effectiveness and cost effectiveness of interventions. Without ensuring that health technologies are effective and are delivered appropriately then many of the other dimensions of quality may simply be window dressing. Substantial variations in the rates of procedures, the way in which similar patients are treated, and the degree to which professionals often ignore the best scientific evidence have all been well documented. The NHS needs methods for ensuring that the effectiveness dimension of quality is brought to the fore and becomes a routine part of quality assessment and activity. Clinical autonomy can no longer be an excuse for inappropriate care. The challenge for the future is twofold: to increase the amount of health technology assessment carried out and to develop methods of ensuring that health care converges with this best practice--that is, the promotion of evidence based practice. By introducing evidence based clinical guidelines and associated utilisation review and persuading purchasers to "purchase protocols" rather than just procedures the effectiveness dimension may become more routine, but it will require a radical rethink of the type of data collected and the way in which the purchaser provider split is managed. (+info)
Acute childhood diarrhoea and maternal time allocation in the northern central Sierra of Peru.
Interventions to improve child health depend, at least implicitly, on changing maternal knowledge and behaviour and a reallocation of maternal time. There have been few studies, however, of the time cost involved in the adoption of new health technologies and even fewer that examine changes in maternal activities in response to child illness. The present study examines maternal daytime activities and investigates changes that occur when children are ill. We examine the impact of acute childhood diarrhoea episodes on the activity patterns of the mother/caretaker in this setting. The results show that mothers alter their usual activity patterns only slightly in response to acute diarrhoea episodes in their children. They continue to perform the same variety of activities as when the children are healthy, although they are more likely to perform them with the child 'carried' on their back. There is some indication that diarrhoea perceived to be more severe did result in the mother acting as caretaker more frequently. These findings have important implications for health interventions that depend on changing the amount of maternal or caretaker time spent for child health technologies, but the implications may vary depending on the reasons for the observed lack of changes in caretaker activities. (+info)
Measuring time utilization in rural health centres.
OBJECTIVES: During the recent re-design of the primary health care system in Cameroon a time-motion study was undertaken to determine how health workers at rural health centres use their time before redefining their roles. METHODS: The study developed a simple, effective and inexpensive tool which uses the activity sampling technique, and was applied to 20 health centres with a total of 19,080 observations being made of 64 health workers who represented all grades of worker in the government health services. RESULTS: The study developed a clear picture of how health centre staff apportion their time, and how the division of labour and tasks is carried out in a rural health centre. It found that only 27% of health workers' time is currently being spent on productive, health-related activities, and of this time, the largest proportion is spent on curative, clinical work. Less than 1% of health workers' time is spent on preventive and outreach activities. DISCUSSION: This study has developed a simple and inexpensive tool which can be used in any health facility to determine how health-related activities are carried out. This is an important step if changes in the delivery structure are to be made, because it establishes the discrepancy between expected and actual behaviour, and provides an important baseline for the evaluation of the effectiveness of any changes that are introduced within the system. (+info)
Patient waiting times in a physician's office.
This observational study measured waiting times, appointment durations, and scheduling variables of a single family practice physician. Waiting time and appointment duration in four sequential groups of sessions were compared using analysis of variance; each group used different scheduling templates. Groups 1 and 2 used a 15-minute base interval; group 3 used a 20-minute base interval. Observations for group 4 were collected at a different health center using a 15-minute base interval. Scheduling variables were correlated with waiting time using correlation coefficients, and data were collected on 1783 appointments. The best waiting time (mean +/- SD) was 17.33 +/- 19.19 minutes. The mean appointment duration for this group was 17.99 +/- 7.97 minutes. The F statistic comparing the four groups of sessions for waiting times was 34.14 and for appointment duration was 37.37, both of which are significant (P < 0.001). The Spearman correlation coefficient for waiting time with queue was 0.2474 (P < 0.001). The Spearman correlation coefficients for mean waiting time and lateness of starting a session (0.4530), patients per hour (0.3461), and patients per session (0.3674) were all significant (P < 0.001). Both scheduling and patient flow affect patient waiting times. The best schedule would consist of shorter sessions that started on time and were extended to accommodate extra patients rather than adding in patients and crowding the schedule. In addition to reducing the actual waiting times, the perception of waiting can be managed to minimize patient dissatisfaction. (+info)
Do physicians spend more time with non-English-speaking patients?
OBJECTIVE: To determine whether physicians at a general internal medicine clinic spend more time with non-English-speaking patients. DESIGN: A time-motion study comparing physician time spent with non-English-speaking patients and time spent with English-speaking patients during 5 months of observation. We also tested physicians' perceptions of their time use with a questionnaire. SETTING: Primary care internal medicine clinic at a county hospital. PATIENTS/PARTICIPANTS: One hundred sixty-six established clinic patients, of whom 57 were non-English speaking and 109 were English speaking, and 15 attending physicians and 8 third-year resident physicians. MEASUREMENTS AND MAIN RESULTS: Outcome measures included total patient time in clinic, wait for first nurse or physician contact, time in contact with the nurse or physician, physician time spent on the visit, and physician perceptions of time use with non-English-speaking patients. After adjustment for demographic and comorbidity variables, non-English-speaking and English-speaking patients did not differ on any time-motion variables, including physician time spent on the visit (26.0 vs 25.8 minutes). A significant number of clinic physicians believed that they spent more time during a visit with non-English-speaking patients (85.7%) and needed more time to address important issues during a visit (90. 4%), (both p <.01). Physicians did not perceive differences in the amount they accomplished during a visit with non-English-speaking patients. CONCLUSIONS: There were no differences in the time these physicians spent providing care to non-English-speaking patients and English-speaking patients. An important limitation of this study is that we were unable to measure quality of care provided or patients' satisfaction with their care. Physicians may believe that they are spending more time with non-English-speaking patients because of the challenges of language and cultural barriers. (+info)
Trauma center maturation: quantification of process and outcome.
BACKGROUND AND OBJECTIVE: The regional trauma system with the trauma center as its center is a model for health care networks. However, trauma center maturation has not been defined in the literature. The authors' hypothesis was that maturation of the trauma center would affect quantitatively both process and patient outcome. MATERIALS AND METHODS: A total of 15,303 trauma patients were admitted from 1987 to 1995. Annual admissions increased from 813 to 2669. Resources were generated as patient volume increased. Time to the operating room, length of stay, and complications were determined. TRISS methodology was used to calculate z scores and w values to compare actual with predicted mortality rates. RESULTS: Time to the operating room for laparotomy decreased from 62+/-73 to 35+/-47 minutes, from 32+/-32 to 20+/-17 minutes in hypotensive patients, and for craniotomy decreased from 88+/-54 to 67+/-49 minutes. The incidence of infectious, airway, neurologic, orthopedic, respiratory, gastrointestinal, and procedure-related complications declined significantly. Z scores and w values increased for penetrating and blunt injuries. Deaths for patients with ISS >15 declined significantly. Hospital length of stay decreased for all ranges of injury severity. CONCLUSIONS: As the trauma center matured, the process of delivering patient care became more efficient. The result was improved survival, fewer complications, and a shorter length of stay. (+info)