Chaperones in ENT out-patients; the patients' perspective.

Chaperones are used in order to avoid misunderstandings that can lead to false accusations. Consultations and examinations may be a minefield especially if the doctors are accused of sexual misconduct. The allegations may have irreparable effects on their reputation and may lead to removal from the medical register and to criminal charges being brought. We present the results of a questionnaire from 85 patients, exploring patient experience in ENT out-patients particularly with respect to examination of the ear under the microscope. This procedure necessitates close contact between the patient and doctor for several minutes and there may be inadvertent contact with intimate areas on the patient. Up to 30 per cent of patients expressed a preference for a chaperone during the ENT consultation. There was noticeably a greater proportion of men than women patients stating a preference for a chaperone during the consultation. Interestingly, there was a strong positive correlation between the presence of friends/relatives and the preference for a chaperone. Patients should be given the freedom to choose for or against the presence of a chaperone in clinic consultations. The most commonly predicted scenario requiring a chaperone is with the male doctor and female patient. This study shows that based on patient feedback, this scenario, although common is not the exclusive area in which chaperones should be used.

Security department orientation of patient-prisoner escorts.

Forensic staff--police officers, corrections officers, or other escorts of patient-prisoners--frequently are unaware of hospital rules and procedures. The article describes guidelines for medical police and hospital security for briefing forensic staff and dealing with patient-prisoners.

Rising to the challenge: portering services at the Queen Elizabeth II Health Sciences Centre.

With the recent formation of the Queen Elizabeth II Health Sciences Centre in Halifax, Nova Scotia, a number of challenges have arisen that must be addressed. One involves the porter service, which faces increased demands since every department has new and often expanded duties for porters. This paper identifies obstacles facing the porter service and develops recommendations, which may also be of interest to other healthcare facilities facing similar challenges.

TQM brings collaboration to patient transport process.

Total quality management (TQM) principles can be utilized to achieve successful outcomes of an interdepartmental problem-solving process prior to implementation of a TQM formal structure within an organization. Prior to implementation of the new process, patient transport time from nursing units to lab destination was calculated at 17.6 minutes; postimplementation, an institutional benchmark of 15.4 minutes has been set. The mechanisms utilized for development, implementation, and evaluation of a process improvement team is the focus of the article. The reader will be taken on a journey through an interdepartmental problem-solving process utilizing the TQM principles.

Interruption of oxygen therapy during intrahospital transport of non-ICU patients: elimination of a common problem through caregiver education.

UNLABELLED: Hospital inpatients frequently leave their rooms for diagnostic procedures and for other reasons. For some, interruption of oxygen therapy during transport could lead to serious complications. In our institution, non-ICU patient transport is done mainly by nonclinical personnel from an independent transport service. MATERIALS & METHODS: We reviewed respiratory care department and transport service records for 5 arbitrarily selected days to determine the number of non-ICU patients receiving O2 therapy, the number of times these patients were transported, and the number of occasions on which O2 was used during the transport. We then interviewed the primary nurse for each patient transported without O2 and reviewed the charts of those patients to determine whether this practice was consistent with the therapy as it had been ordered. After our initial investigation showed a high rate of transport without prescribed O2, we sent memoranda to all nursing units describing proper procedures for transport of patients for whom O2 had been ordered. We then repeated the audit. Because the second audit showed the need, we conducted education sessions with all nursing personnel on the affected units and posted guidelines for O2 use during transport. A third audit was then conducted. In addition, we performed a telephone survey of respiratory care department managers to learn the patient-transport practices in all hospitals in our state with more than 200 beds, using a structured questionnaire. RESULTS: During the initial 125 patient-days of O2 therapy, O2 accompanied patients on only 30 of 55 transports (55%). After distribution of memoranda, O2 use increased to 28 of 35 transports (80%) during 82 patient-days. The second educational effort resulted in O2 use with all 35 transports (100%) performed during 99 patient-days. Survey results from 24 hospitals with 225-680 beds showed that 11 (46%) had separate transport services and that decisions on O2 use during patient transport were generally made by nursing staff. Although respiratory care departments supplied the O2 equipment, their personnel were involved in non-ICU transports in only 5/24 hospitals. CONCLUSIONS: Patients receiving O2 therapy on acute-care wards are often transported to other areas of the hospital without O2. This potentially dangerous practice can be corrected by respiratory care practitioners through educational efforts targeted toward those responsible for administering O2 therapy in non-ICU hospital areas.

Transporting acutely ill patients: a framework for radiology.

Concern grew at Ms. Doherty-Simor's institution about the proper care and monitoring of inpatients traveling to the radiology department for exams after-hours and on weekends, when radiology nurses were not usually available. In this article, she reports on the findings of a special task force, proposed solutions and the resultant improvements to patient care.

Quality improvement for a hospital patient transportation system.

This article describes a method for organizing and staffing a hospitalwide patient transportation system in such a way as to minimize patient waiting times. The method stems from a quality improvement project and includes a centralized communication system, a queuing model to determine staffing requirements, and a computerized data collection and monitoring system. A case study demonstrates improvements in waiting times, costs, and customer satisfaction.

Improving the patient transfer process at Bellin Hospital.

PROJECT: To facilitate timely and efficient transfers of patients on the cardiac service. PRINCIPALS: Nursing staff from the intensive care (ICU), intermediate care (IMCU), and step down units. Process Improvement Method: VALUE PLUS+, a scientific, problem-solving model developed at Bellin that requires statistical thinking. Timeline: March 1990-August 1991. Key Findings or Improvements: Mid-morning, early afternoon, and early evening are the ideal times for patient transfers; late morning and mid-to-late afternoon transfers should be avoided. Unit staff can plan transfers for preferable times by predicting the number of transfers from ICU and IMCU, based on a percentage of the previous day's census. RESULTS: The number of process steps to transfer a patient was reduced from 21 to 13. 80 percent of transfers now occur during three designated time periods. The role of transport staff has been expanded to free up nursing time.

Total quality management at Bethesda, Inc.

This article describes 4 years of TQM implementation at Bethesda, Inc., a private not-for-profit diversified healthcare organization. Bethesda has used a comprehensive implementation strategy involving the use of process improvement teams, hoshin planning, daily management of critical processes, and quality function deployment. The article includes four process improvement case studies demonstrating the use of the seven quality control tools and a nine-step process improvement model. Factors contributing to processes as well as obstacles are described.

A patient transport pilot quality improvement team.

The transportation of inpatients within the hospital is a critical component of the patient care process. A quality improvement (QI) team at Massachusetts General Hospital (Boston) convened to improve this process and to pilot the QI approach there. Pilot QI projects have the burden of intense scrutiny by senior management at a point when the fundamentals needed for a successful QI project are scarce or not yet available. The authors, who were participants in this project, describe the methodology and outcomes of this pilot QI process as well as the lessons learned. The results confirm that, although difficult, it is possible to succeed in pilot projects and gain the support needed to move on to the next step in the QI journey.

Introducing a quality of service programme to hospital orderly staff.

Recent reshaping of health provision throughout New Zealand has brought many changes to virtually every area of the service. In some instances this has required a totally fresh approach with a different way of thinking. In others, it has meant the adaptation and remodelling of existing structures and approaches. This paper gives a brief overview of the West Auckland Health District Quality of Service Programme and, in particular, its introduction to the orderly service at Waitakere Hospital.

Designing healthcare transportation for the elderly: an empirical study.

The growing elderly market in the United States has spawned a number of studies examining different aspects of the elderly market such as their expenditure patterns, healthcare needs, attitudinal types, etc. One of the least studied areas in this field is the transportation of the elderly to their primary health care facilities. This study was undertaken to assess the likelihood of adoption by the elderly of two proposed transportation alternatives by a hospital in a major metropolitan area: a shuttle service and an escort service. The receptivity to the proposed new service was hypothesized to differ across age subsegments among the elderly. Five-hundred and fifty-three elderly, selected at random, were studied in telephone interviews. The results show that the escort service was received more favorably than the shuttle service and the 75+ age group was the most receptive to the two services. The 71-75 age group appeared to be the least receptive to the proposed services.