In outpatient clinics, consultation times are often eroded by extraneous activities. We measured the components of each outpatient episode in 167 patients attending a general urology follow-up clinic. 41% of time in the clinic was spent away from the patient-administration 17%, disturbances 15%, finding results 9%. The inefficiencies had changed little since a study in the same setting thirteen years earlier. Since then, parallel nurse-practitioner-run clinics have been introduced in the hope of giving consultants longer with the patient; however, time with each patient is now 4.8 min compared with a previous 7.6 min. The most easily addressed inefficiencies are those relating to missing information, such as radiology reports. (+info)
Cost of urology: financial audit in a clinical department.
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OBJECTIVES: To cost a clinical unit over one month in 1991, to cost treatment of individual patients from audit data, and to compare this costing method with the hospital charging system. DESIGN: A financial breakdown was obtained for one month's work. Ward stay, operating time, investigations, and outpatient visits were costed and a formula (episode = days on ward+hours of operating+investigations+outpatient visits) was used to cost patient episodes from audit data. SETTING: The adult urology unit in a teaching hospital. MAIN OUTCOME MEASURES: Costs for each part of patients' treatment. RESULTS: Total cost was 147,796 pounds for 159 admissions, 738 inpatient days, 131 operations in 29 operating lists, and 615 outpatient visits. An uncomplicated transurethral prostatectomy cost 1140 pounds but complications increased this to 1500 pounds in another patient. The costs of diagnostic cystoscopy were 130 pounds in outpatients, 240 pounds in day surgery, and 430 pounds in inpatients. Hospital charges do not reflect the individual costs of treatment, charges being greater than costs for some patients and lower than costs for others. CONCLUSIONS: Clinicians can produce a financial analysis of their work and cost their patients' treatment. Audit is strongly advocated as a resource planning tool. (+info)
The (fixed) urinary sediment, a simple and useful diagnostic tool in patients with haematuria.
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Examination of the urinary sediment is a simple and indispensable tool in the diagnostic approach to patients with asymptomatic haematuria. Various glomerular and nonglomerular diseases can cause haematuria. A well-trained expert can distinguish between these two forms of haematuria by examining the urinary sediment under a simple light microscope. In glomerular haematuria, dysmorphic erythrocytes and erythrocyte casts are found, whereas in nonglomerular haematuria the erythrocytes are monomorphic and erythrocyte casts are absent. However, few people have sufficient expertise in the examination of the urinary sediment, and consequently this investigation is performed far too seldom. A few years ago, a simple method of fixation of the urinary sediment became available. Fixed specimens can be stored at room temperature for at least two weeks, which enables the sending of a fixed specimen to an expert examiner by regular mail. In this way, the urinary sediment can more frequently be used as the initial investigation in the diagnostic route of patients with asymptomatic haematuria. (+info)
Rape and sexually transmitted diseases: patterns of referral and incidence in a department of genitourinary medicine.
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A retrospective study was carried out of all women attending a Department of Genitourinary Medicine over a 3-year period. Note was taken of referring source, presenting symptoms, infection detected at STD screening and follow-up attendance. Comparison was also made between the number of women referred by the police surgeon and the number who actually attended. We observed an overall incidence of STD of 35% and noted that many infections had a similar prevalence to that of our normal clinic population over the same time period. Only 13% of the women referred by the police attended although after the initial visit attendance was similar regardless of referral source. A number of asymptomatic women were noted to have infection with Neisseria gonorrhoeae and Chlamydia trachomatis. Although, the risk of significant STD following sexual assault is low greater efforts should be made to encourage women to attend for screening whether or not they are symptomatic. (+info)
Prospective evaluation of a novel one-stop testicular clinic.
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The central urology multidisciplinary team - is it time to change the referral criteria? An audit of practice in a district general hospital in London.
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