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At least 127 records · Page 7Linked to original sources

A work sampling study of midlevel health professionals in a rural medical clinic.

A work sampling study was initiated to provide a comprehensive description of the tasks performed by midlevel health personnel in the rural component of an experimental medical care delivery system. The investigation determined the proportion of time spent on various activities by the staff members of a rural clinic which is linked to supervisory physicians in a distant urban medical center. Over 800 observations were recorded during ten randomly selected days in a two-month period on each of the three staff members. The family nurse practitioner spent one-third of her time in direct patient care activities with almost one-half of the day devoted to indirect patient care tasks. The laboratory aide allocated one-half of her day to providing direct patient services whereas the clerk-receptionist spent over 40 per cent of her day on patient records and billing. Work sampling results were considered within a comparative framework to qualitatively assess performance. The findings were coupled with proposed changes in administrative and medical policy to provide a quantitative basis for developing cost-reducing alternative staffing configurations.

Allied Health Personnel↗

Sports for the physically disabled. The 1976 Olympiad (Toronto).

The 1976 Olympiad for the Physically Disabled was the first olympiad with full competition for blind, paralyzed, and amputee athletes. More than 1,500 from 38 countries took part in wheelchair (12 events), blind (8 events), and amputee (11 events) games. Participants were classified by an international team of doctors. The athletes were accomodated in university residences with small infirmaries. A school near the games site was used as a field hospital. Rest areas were also set up. Volunteers served on the medical staff (three doctors, three nurses, three receptionists, and three physical therapists on each of two shifts per day). In addition doctors, nurses, trainers, and physical therapists rotated around various venues at the games site. Physicians treated 285 patients (184 were athletes; others were spectators) for a variety of problems, physical therapists treated 119 athletes, and trainers treated 114 athletes. Contigency plans in case of mass disaster were made but were not needed. Disabled athletes are slightly more vulnerable to stress and fatigue than able-bodied athletes. The Toronto games will probably be remembered as the turning point in the emergence of sports for the disabled from a purely rehabilitation measure to a true sporting event in its own right.

Amputees↗

Improving customer service. It's not just what's in the box.

Patient satisfaction scores can plummet when medical emergencies throw schedules into disarray or a receptionist ignores a patient at the front desk. Patients' expectations of good customer service have been shaped by technological conveniences and the concerted efforts of retailers, restaurants and other service providers. Physician leaders and administrators can improve customer service by paying more attention to organizational culture, physician behavior, staff incentives, hiring practices and team-building.

Appointments and Schedules↗

3 case studies: installation of computerized appointments, a computerized chart-tracking system, and telautowriters.

Problem situations are unavoidable in the daily routines of the medical group administrator. It is the method used to handle these situations that points out an administrator's skill. In the following three case studies, the problems of appointment scheduling, medical record tracking, and communication between appointment clerks, front desk receptionists, and nurses are presented. The problems are thoroughly addressed from beginning to end, through the stages of initial identification, seeking alternatives, recommendations, groundwork, implementing solutions, and analyzing final results.

Appointments and Schedules↗

An investigation of causes of patient satisfaction/dissatisfaction with physician services.

To provide the highest level of satisfaction, health care providers must control patients' expectations and perception of treatment quality. This study is designed to gain insight into the perception and attitudes of consumers toward physician services. It attempts to examine the satisfaction/dissatisfaction of patients in association with the cost and quality of medical care; interpersonal skills, competence and professional recognition of physicians; information provided and attention given by physicians; waiting time, physical facilities, and receptionists and nurses in the physicians office. Data was gathered using telephone interviews from a sample of 245 respondents. Factor analysis techniques in the SPSSX software package were used in data analysis. Findings indicated that there are generally favorable attitudes toward the quality of medical services, and that medical cost has secondary importance.

Data Collection↗

Feasibility of contact surveys in general practice.

Surveys to evaluate risk factors for disease in the general population are popular with health authorities for assessing the effectiveness of their preventive measures. A contact survey of the lifestyles of 2000 randomly selected patients aged 25-64 was conducted in five general practices over 18 months; the medical records of the patients selected were tagged, and when the patients first visited the surgery they were given a questionnaire by the receptionists, which they completed in the waiting room. Over the 18 months at least 1400 of these patients visited the practices, of whom 1106 (55%) completed a questionnaire and 20 refused to do so; 896 (81%) completed it within one year. Information on the patients who were not surveyed was obtained by sending the questionnaire by post and by audit of medical records. The population surveyed on contact with the surgeries contained a higher proportion of young women, and possibly a higher proportion of patients from social classes IIIM-V, than the other patients. No important or consistent bias towards unhealthy patients at high risk was identified in the contact survey. A one year contact survey of a random, tagged sample is feasible in estimating the risk factors in a population and may be the method of choice in general practice because of its low cost and adaptability.

Adult↗

The list system can reduce the waiting time and number of consultations in a centralized primary care centre that provides out of hours medical care.

OBJECTIVE: To study the waiting time and number of consultations of the patients who required out of hours medical care from a centralized primary care centre before and after the introduction of a list system. DESIGN: Non-controlled intervention study. A questionnaire, completed by receptionists, concerning all out of hours general practice consultations for one week each month during two separate years (in 1990 with no list system and in 1993 with list system in operation). SETTING: One health centre in central Finland in a region with 39495 inhabitants. SUBJECTS: All patients contacting the health centre to request medical help during out of hours work. OUTCOME MEASURES: Consultation rates by age and sex of the patients and their waiting time before seeing the GP. RESULTS: In 1990, the average out of hours consultation rate per 1000 inhabitants per year was 826 for women and 819 for men. These figures were reduced by 271 for women (95% CI 262-280) and 305 for men (95% CI 297-314) in 1993. The mean waiting time was 55 min in 1990 and 32 min in 1993 (p < 0.001). CONCLUSION: The introduction of a list system leads to more effective primary care services.

Adolescent↗

Turn account settlement into a PR exercise.

In general practice it will cost 20 to 25 per cent of the average consultation fee to collect the fee by sending accounts. One might well ask the question: Who can afford to lose that amount of the present consulting fee and still survive economically? At the same time as the fee settlement, the receptionist can help the patient and aid practice efficiency.

Fees, Medical↗

Scheduled appointments and patient-staff compliance.

Studies of medication compliance have focused primarily on patient resistance to treatment, medication side effects, or the complexity of the medication regimen. This study of patient visits in a large psychiatric clinic found that, because of failure to schedule appointments or to notify receptionists of rescheduled appointments, physician noncompliance was as important as patient failure.

Appointments and Schedules↗

[Round Table: Severe asthma in pediatrics: prevention].

1. Evaluation of individual propensity to severe asthma using risk factors. 2. Regular follow-up at intervals of 3-4 months, regardless of the patient's stability in a given moment. 3. Measurements of pulmonary function at each visit and at home daily (PEF). 4. Monitoring evolution in relation to the need for specialist consultations and psychological care. 5. Factors influencing propensity to death should be treated specifically. 6. Designation of a person outside the family responsible for the patient's care. 7. Use of community resources. 8. Monitoring personal/family compliance with treatment programs. 9. Informing the patient and family about the patient's tendency to severe asthma. 10. Developing an emergency plan for facilitating communication when asthma becomes unstable. The plan should emphasize eliminating any delay in obtaining care during an attack. The plan should include: a) A list of preventive medications with dosing guidelines. The simplest possible regimens should be established. b) Criteria for using rescue medication and emergency care in each specific case. c) When the physician should be called in and what to do when the physician cannot be contacted. d) An exact description of the signs and symptoms that indicate that the patient should visit the emergency room without delay. Advance designation of the emergency service to be used. e) Suitable vacation planning. 11. Mechanisms guaranteeing fluid and effective communication between the unit and patients with severe asthma. a) Programs for physicians, nurses and receptionists who take calls to establish measures for recognizing, identifying risk factors, and preventing complications in patients with severe asthma. b) Compilation of a list of patients with severe asthma. c) Patients with severe asthma should be identified by a medical alert card. d) Calls from patients with severe asthma should be taken immediately.

Anti-Asthmatic Agents↗

In-office cancer-screening education of primary care physicians.

In a demonstration project, education representatives were trained to perform "academic detailing" of cancer control information for physicians and for staff members of family physicians' offices. One-hour visits were arranged at specific times so as to avoid disruption of patient care activities. The representatives led discussions of salient tissues regarding early detection of cancer at three sites (breast, colon-rectum, and prostate) and left relevant patient education materials. Seventeen visits were made to 11 practices involving 22 physicians and 85 staff members. Ten items were selected as evidence of favorable cancer control activities: ashtrays had been removed from the waiting room, patient information was displayed in a wall rack, medical records contained a method for prompting the physician about preventive or screening services that were due to be performed, a recall system reminded patients of services that were due to be performed, the receptionist was involved, the nurse was involved, American Cancer Society (ACS)-recommended services were used or had been added, the physician talked to other physicians about the visit discussions, services or materials had been requested from the local ACS unit, and staff members or physicians had volunteered to serve the ACS. The compliance rate was 35% at baseline. At post-intervention assessment, the compliance rate had increased by 35%, for a final compliance rate of 70%.(ABSTRACT TRUNCATED AT 250 WORDS)

American Cancer Society↗

The feasibility of a potentially 'ideal' system of integrated diabetes care and education based on a day centre.

A new system of clinical and educational care designed to replace traditional diabetic clinics is described. The overall aims were to provide adequate consultation time, patient access according to diabetic and social needs, minimal waiting time, continuity with experienced staff and objective based learning programmes in an environment suited to learning. This was achieved by changing the role of the diabetes nurse specialist from undertaking delegated tasks to providing primary consultative care, reorganization of existing staff and provision of a purpose designed unit. This gave sufficient flexibility to arrange daily early morning and weekly evening clinic sessions for routine diabetes counselling and medical audit with primary education scheduled at other times. A year's experience showed that our major targets had been met, with the provision of adequate consultation time, halving of waiting time, ease of patient access and continuity with either the doctor or nurse in consulting role. Default rates have fallen and patient and staff morale has improved substantially. Apart from an underestimate of receptionist and a small increase in technician hours, these changes have been achieved within the predicted small revenue cost.

Appointments and Schedules↗

Tuberculin reactivity among health care workers in nonhospital settings.

BACKGROUND: We used workers' compensation data to identify health care workers at risk of tuberculosis exposure in the hospital and nonhospital environment. METHODS: We identified State Fund workers' compensation claims having a documented tuberculin skin test (TST) conversion (size >or=10 mm) with a previous negative skin test between 1996 and 2000 in the State of Washington. RESULTS: Health care workers experienced an overall accepted workers' compensation claim rate of 2.3 claims/10,000 full-time equivalent employees (FTEs) per year for tuberculin reactivity. Receptionists accounted for the largest number, with 18.4% tuberculin reactivity claims. The number of tuberculin reactivity claims was the highest for offices and clinics of doctors of medicine (3.7 per 10,000 FTEs), followed by medical laboratories (2.6 per 10,000 FTEs). CONCLUSION: This study allowed characterization of employees in various nonhospital health services locations with higher number of tuberculin reactivity.

Adult↗

The cost implications of academic group practice. A randomized controlled trial.

We evaluated the reorganization of a general medical clinic into several group practices, using equivalent groups of patients and physicians in a randomized controlled trial. The group practice, unlike the traditional clinic, provided decentralized registration, clinic coverage five days a week, and telephone coverage at night and on weekends. Residents worked in small groups with an attending physician, nurse practitioner, and receptionist. All financial activity involving a sample of 2299 patients was followed during the 11-month intervention. The total hospital charges per patient were 26 percent lower for the patients seen in the group practice than for those seen in the traditional clinic (P = 0.003). This difference was primarily attributable to inpatient charges, which were 27 percent lower per patient hospitalized (P = 0.004). The mean length of stay was 8.3 days among group-practice patients and 10.5 days among traditional-clinic patients (P = 0.011). We conclude that organizational changes to improve outpatient access and to integrate inpatient and outpatient services can decrease medical charges.

Academic Medical Centers↗