Outcome evaluation of technical strategies on reduction of patient waiting time in the outpatient department at Kilimanjaro Christian Medical Centre-Northern Tanzania.

BACKGROUND: The Tanzania healthcare system is beset by prolonged waiting time in its hospitals particularly in the outpatient departments (OPD). Previous studies conducted at Kilimanjaro Christian Medical Centre (KCMC) revealed that patients typically waited an average of six hours before receiving the services at the OPD making KCMC have the longest waiting time of all the Zonal and National Referral Hospitals. KCMC implemented various interventions from 2016 to 2021 to reduce the waiting time. This study evaluates the outcome of the interventions on waiting time at the OPD. METHODS: This is an analytical cross-sectional mixed method using an explanatory sequential design. The study enrolled 412 patients who completed a structured questionnaire and in-depth interviews (IDI) were conducted among 24 participants (i.e., 12 healthcare providers and 12 patients) from 3rd to 14th July, 2023. Also, a documentary review was conducted to review benchmarks with regards to waiting time. Quantitative data analysis included descriptive statistics, bivariable and multivariable. All statistical tests were conducted at 5% significance level. Thematic analysis was used to analyse qualitative data. RESULTS: The findings suggest that post-intervention of technical strategies, the overall median OPD waiting time significantly decreased to 3 h 30 min IQR (2.51-4.08), marking a 45% reduction from the previous six-hour wait. Substantial improvements were observed in the waiting time for registration (9 min), payment (10 min), triage (14 min for insured patients), and pharmacy (4 min). Among the implemented strategies, electronic medical records emerged as a significant predictor to reduced waiting time (AOR = 2.08, 95% CI, 1.10-3.94, p-value = 0.025). IDI findings suggested a positive shift in patients' perceptions of OPD waiting time. Problems identified that still need addressing include, ineffective implementation of block appointment and extension of clinic days was linked to issues of ownership, organizational culture, insufficient training, and ineffective follow-up. The shared use of central modern diagnostic equipment between inpatient and outpatient services at the radiology department resulted in delays. CONCLUSION: The established technical strategies have been effective in reducing waiting time, although further action is needed to attain the global standard of 30 min to 2 h OPD waiting time.

Comparison of Outpatient Department-Referred and Self-Referred Patients in the Emergency Department.

BACKGROUND: Patients present to emergency departments (EDs) from a variety of backgrounds, which may help inform decision making. OBJECTIVE: This study investigated the clinical characteristics and outcomes of outpatient department (OPD)-referred patients and self-referred patients in the ED. METHODS: We selected nontrauma ED adult patients from a tertiary teaching hospital in Taiwan between August 1, 2020, and October 31, 2020. The acuity levels were determined by dichotomizing the triage classification scores. After propensity score matching, we compared the hospitalization, mortality, and length of ED stay of OPD-referred and self-referred patients. We categorized the patients into "emergency" or "urgent" subgroups according to their triage information and then analyzed the effects of different severity levels. Statistical significance was set at p < 0.05. RESULTS: A total of 564 OPD-referred and 11,959 self-referred patients were included. After propensity score matching, the OPD-referred patients (n = 564), compared with self-referred patients (n = 564), had a higher admission rate (49.8% vs. 28.9%; p < 0.001; odds ratio [OR] 2.44). Among the emergency subgroup patients, there was no significant difference between OPD-referred patients (n = 131) and self-referred patients (n = 138) regarding the admission rate (p = 0.257) or the mortality rate (p = 0.253). Among the urgent subgroup patients, OPD-referred patients (n = 433), compared with self-referred patients (n = 426), had a significantly higher admission rate (46.0% vs. 20.2%; p < 0.001; OR 3.36), but not mortality rate (2.1% vs. 0.5%; p = 0.064). Regarding the length of ED stay, OPD-referred and self-referred patients had a significant difference only in the "urgent and discharged" subgroup (5.8 vs. 2.3 h; p < 0.001). CONCLUSIONS: OPD-referred ED patients might have more severe and complex conditions and need comprehensive care management.

Effect of surgery setting for outpatient shoulder procedures on early postoperative complications in a military population.

BACKGROUND: There has been a recent push to transition procedures previously performed at hospital-based outpatient surgical departments (HOPDs) to ambulatory surgery centers (ASCs). However, limited data regarding differences in early postoperative complications and care utilization (eg, emergency department visits and unplanned admissions) may drive increased overall costs or worse outcomes. PURPOSE/HYPOTHESIS: The purpose of this study was to examine differences in early 90-day adverse outcomes and postoperative emergency department visits associated with shoulder surgeries excluding arthroplasties that were performed in HOPDs and ASCs in a closed military health care system. We hypothesized that there would be no difference in outcomes between treatment settings. METHODS: We retrospectively evaluated the records for 1748 elective shoulder surgeries from 2015 to 2020. Patients were considered as 1 of 2 cohorts depending on whether they underwent surgery in an ASC or HOPD setting. We evaluated groups for differences incomplexity, surgical time, and medical risk. Outcome measures were emergency department visits, unplanned hospital admissions, and complications within the first 90 days after surgery. RESULTS: There was no difference in 90-day postoperative emergency department visits between procedures performed at HOPDs (n = 606) and ASCs (n = 1142). There was a slight increase in rate of unplanned hospital admission within 90 days after surgery in the HOPD cohort, most commonly for pain or overnight observation. The surgical time was significantly shorter (105 vs. 119 minutes, P < .01) at the ASC, but there was no difference in case complexity between the cohorts (P = .28). DISCUSSION/CONCLUSION: Our results suggest that in appropriate patients, surgery in ASCs can be safely leveraged for its costs savings, efficiency, patient satisfaction, decreases in operative time, and potentially decreased resource utilization both during surgery and in the early postoperative period.

Outcomes of elective peripheral endovascular interventions for peripheral arterial disease performed in hospital outpatient departments, ambulatory surgical centers and office-based labs.

BACKGROUND: A recent shift in the location where peripheral endovascular interventions (PVI) are performed has occurred, from traditional settings such as hospital outpatient departments (HOPD), to ambulatory surgical centers (ASC) and outpatient-based laboratories (OBL). Different settings may influence the safety and efficacy of the PVI, as well as how it is done. This study aims to compare the postprocedural outcomes and intraprocedural details between the three settings. METHODS: The Vascular Quality Initiative database was queried for all elective infrainguinal PVIs for occlusive peripheral arterial disease between January 2016 and December 2021. The primary outcomes were rates of postprocedural hospital admissions, postprocedural medical complications, and access site complications. Secondary outcomes included technical success and intraprocedural details, such as types and number of devices used, amount of contrast, and fluoroscopy time. The χ2 test, analysis of variance, and multivariate logistic regression were used to analyze the outcomes. RESULTS: A total of 66,101 PVI cases (HOPD, 57,062 [83.33%]; ASC, 4591 [6.95%]; OBL, 4448 [6.73%]) were included in the study. There were 445 cases requiring hospital admission (HOPD, 398 [0.70%]; ASC, 26 [0.57%]; OBL, 21 [0.47%]; P = .126). There were no significant differences in cardiac, pulmonary, or renal complications. Access site complications occurred in less than 1.7% of all cases and were significantly higher in OBLs when compared with ASCs (adjusted odds ratio [aOR], 3.70; 95% confidence interval [CI], 1.70-8.03; P = .001) and significantly lower in ASCs in comparison to HOPDs (aOR, 0.27; 95% CI, 0.18-0.41; P < .001). Technical success occurred in at least 92% of all cases, regardless of setting. There was a 16-fold increase in the use of atherectomy devices in an OBL vs HOPD setting (aOR, 16.79; 95% CI, 11.77-23.95; P < .001) and a five-fold increase in the use of atherectomy devices in an ASC vs HOPD setting (aOR, 5.37; 95% CI, 2.47-11.65; P < .001). There was a five-fold decrease in the use of special balloons in an OBL vs HOPD setting (aOR, 0.20; 95% CI, 0.10-0.39; P < .001) and a four-fold decrease when comparing ASCs with HOPDs (aOR, 0.25; 95% CI, 0.12-0.51; P < .001). CONCLUSIONS: Elective PVIs performed in any outpatient setting proved to be safe and technically successful. However, there are significant differences in the way PVIs are performed in each setting, such as the greater use of atherectomy devices in OBLs and greater use of special balloons in HOPDs. Long-term studies are needed to evaluate the durability and reintervention outcomes and understand factors associated with practice pattern variability across these different settings.

Telemedicine in diabetic ulcer management: A pilot study with exploration of medico-legal aspects.

BACKGROUND AND AIMS: This study aimed to evaluate the quality and efficiency of telemedicine in managing patients with chronic diabetic ulcers and provide an overview of the main medico-legal implications associated with telemedicine management of diabetic foot complications. METHODS AND RESULTS: A total of 50 patients with type 2 diabetes mellitus were enrolled from a diabetic foot outpatient clinic in Cyprus between March and May 2022. Participants completed a survey concerning telemedicine services, and the demographic variables and average responses to the PACIC (Patient Assessment of Chronic Illness Care) questions were examined using descriptive analysis. The majority of patients (84%) were male, with a mean age of 60.9 ± 13.05 years. The average PACIC score was 4.42 (min. 2.7 and max. 5.0). Voice calls were the most preferred method of telemedicine delivery, accounting for 53% of all services. CONCLUSION: Telemedicine can effectively manage chronic patients, such as those with diabetic ulcers, by reducing the burden on resources and maintaining service quality. However, healthcare professionals must be well-versed in medico-legal implications to adhere to legal and ethical guidelines, protect patient privacy, and maintain high standards of care while using telemedicine for chronic condition treatment.

Pattern of OPD utilisation during the COVID-19 pandemic under the Universal Coverage Scheme in Thailand: what can 850 million records tell us?

BACKGROUND: Out-patient department (OPD) is a crucial component of the healthcare systems in low- and middle-income countries including Thailand. A considerable impact of coronavirus disease 2019 (COVID-19) pandemic and its control measures, especially the lockdown, on utilisation of OPD services was expected. This study thus aims to estimate the pattern of OPD utilisation during the COVID-19 pandemic in Thailand including overall utilisation and within each sub-groups including diagnostic group, age group, and health region. METHODS: This study was a secondary data analysis of aggregated outpatient data from patients covered under the Universal Coverage Scheme (UCS) in Thailand over a 4-year period (2017-2020). Interrupted time series analyses and segmented Quasi-Poisson regression were used to examine the impact of COVID-19 on the overall OPD utilisation including the impact on each diagnostic group, age groups, health regions, and provinces. RESULTS: Analysis of 845,344,946 OPD visits in this study showed a seasonal pattern and increasing trend in monthly OPD visits before the COVID-19 pandemic. A 28% (rate ratio (RR) 0.718, 95% confidence interval (CI): 0.631-0.819) and 11% (RR 0.890, 95% CI: 0.811-0.977) reduction in OPD visits was observed during the lockdown and post-lockdown periods, respectively, when compared to the pre-lockdown period. Diseases of respiratory system were most affected with a RR of 0.411 (95% CI: 0.320-0.527), while the number of visits for non-communicable diseases (ICD-10: E00-E90, I00-I99) and elderly (> 60 years) dropped slightly. The post-lockdown trend in monthly OPD visits gradually increased to the pre-pandemic levels in most groups. CONCLUSIONS: Thailand's OPD utilisation rate during the COVID-19 lockdown decreased in some diseases, but the service for certain group of patients appeared to remain available. After the COVID-19 lockdown, the rate returned to the pre-pandemic level in a timely manner. Equipped with a knowledge of OPD utilisation pattern during COVID-19 based on a national real-world database could aid with a better preparation of healthcare system for future pandemics.

Perceived quality of medical services at outpatient department of public hospitals in Dawro Zone, Southern Ethiopia.

BACKGROUND: Quality of care is fundamental to universal health coverage. Perceived quality of medical services is one of the most determining factors of modern health care service utilization. Between 5.7 and 8.4 million deaths are attributed to poor-quality care each year in low- and middle-income countries (LMICs), and up to 15% of overall deaths are due to poor quality. For instance, in sub-Saharan Africa (SSA), public health facilities lack basic facilities such as a physical environment. Hence, this study aims to assess the perceived quality of medical services and associated factors at outpatient departments of public hospitals in the Dawro zone, Southern Ethiopia. METHODS: A facility-based cross-sectional study was conducted on the quality of care among outpatient department attendants of Dawro zone public hospitals from May 23 to June 28, 2021. A total of 420 study participants were included via a convenient sampling technique. An exit interview was used to collect data using a pretested and structured questionnaire. Then it was analyzed using the Statistical Package for Social Science (SPSS) version 25. Both bivariable and multivariable linear regressions were carried out. Significant predictors were reported at p < 0.05 with a 95% confidence interval. RESULT: with a 100% response rate. The overall perceived quality was 51.15%. Fifty-six percent of study participants rated perceived quality as poor, 9% as average, and 35% of participants rated it as good perceived quality. The highest mean perception result was related to the tangibility (3.17) domain. Waiting time less than one hour (ß = 0.729, p < 0.001), availability of prescribed drugs (ß = 0.185, p < 0.003), having information on diagnoses (illness) (ß = 0.114, p < 0.047), and privacy maintained (ß = 0.529, p < 0.001) were found to be predictors of perceived good quality of care. CONCLUSION: A majority of the study participants rated the perceived quality as poor. Waiting time, availability of prescribed drugs, information on diagnoses (illness), and provision of service with privacy were found to be predictors of client-perceived quality. Tangibility is the predominant and most important domain of client-perceived quality. The regional health bureau and zonal health department should understand the issue and work with hospitals to improve outpatient service quality by providing necessary medication, reducing wait times, and designing job training for health care providers.

Effects of the lockdown measure amid COVID-19 pandemic on outpatient department visits associated with air pollution reduction in Thailand.

We investigated the effects of COVID-19 lockdown on air quality and its consequences health and economic benefits in Thailand. The conditional Poisson regression model was applied to examine the association between air pollution and outpatient department (OPD) visits in each province and pooled the province-specific estimates using the random-effects meta-analysis to derive the national estimates. We then applied a random forest model with meteorological normalization approach to predict the concentration of air pollutants by means of business as usual during the lockdown period (April 3-May 3) in 2020 and further calculated the changes in the number of OPD visits and their consequent expenditure attributable to air pollution reduction using the obtained risk function performed earlier. The number of cardiovascular OPD visits attributed to PM10, PM2.5 and NO2 decreased by 4,414 (95% CI 982, 8,401), 4,040 (95% CI 326, 7,770), and 13,917 (95% CI 1,675, 27,278) cases, respectively, leading to reduced medical expenditure by 14,7180.21, 13,4708.31, and 46,4025.04 USD, respectively. The number of respiratory OPD visits attributed to PM10, PM2.5, NO2, and O3 reduction decreased by 2,298 (95% CI 1,223, 3,375), 2,056 (95% CI 740, 3,252), 3,326 (95% CI 542, 6,295), and 1,160 (95% CI 5,26, 1,804) cases, respectively, where the consequent medical expenditure was reduced by 76,618.48, 68,566.36, 11,0908.31, and 38,685.50 USD, respectively. Finding from this study showed that air quality during the lockdown period in Thailand was improved, contributing to the reduction of cardiovascular and respiratory OPD visits, and consequent medical service costs attributable to air pollution.

Influence of lockdown during the COVID-19 pandemic on use of pediatric emergency health services: A retrospective observational study from a Tertiary Care Hospital in New Delhi.

January 30, 2020, marked the beginning of the COVID-19 pandemic in India. Various emergency measures were taken to contain the spread of COVID-19 including extended periods of complete lockdown. The impact of these measures on routine and emergency health services was unforeseen. Hence, we conducted this study to critically analyze the effects of restrictions imposed during the COVID-19 pandemic (including lockdown) on the utilization of health services, especially emergency services. We compared patient's attendance in the outpatient department and pediatric emergency department (PED) and changes in clinicepidemiological profiles (before and during COVID-19) in a tertiary care hospital. We observed a 43% decline in PED visits which decreased to 75% during the period of strict lockdown (P = 0.005). Reduction in emergency department visits was noticed uniformly in all disease categories. This study highlights the urgent need to plan for robust health-care support system for the delivery of preventive and curative services to vulnerable age groups during any emergency.

PENS approach for breaking bad news in the oncology outpatient setting: a real-world report.

PURPOSE: Breaking bad news (BBN) is a vital part of oncology practice. We conducted this study to assess an abbreviated PENS protocol [Patient preference, Explanation, Next appointment, and Support] for BBN in oncology outpatient (OP) settings. METHODS: This observational study was conducted in a university teaching hospital, including cancer patients who were unaware of their condition and willing to discuss their disease status. The duration of BBN was the primary outcome. After the BBN session, patients filled a validated questionnaire; response scores of ≤ 13 were classified as content with BBN. RESULTS: Fifty patients (mean age 53.7 years, range 28-76) were included in the study. The average duration of BBN was 6.1 (range 2-11) min. Assessed by the response score sum, 43 (86%) patients were satisfied with BBN. Only three (6%) of the discontented patients felt that the BBN duration was too short. Most (94%) of patients reported that they understood the information imparted during the BBN session. After the session, 36 (72%) patients admitted to either feeling the same or reassured compared to before the session. The oncologists also were comfortable with PENS. CONCLUSIONS: The PENS approach is a practical method for BBN, especially when the oncologists have higher OP workloads. More extensive trials are required to validate the protocol in other settings. TRIAL REGISTRATION: Clinical Trial Registry of India (CTRI/2021/07/034707).

[The Effectiveness of a Shared Reading Program Among Parents of Newborns].

BACKGROUND: Early parent-child shared reading has been demonstrated to promote the development of literacy, reading skills and learning achievement in young children. Parent-child shared reading intervention programs may strengthen the willingness and reading competence of parents. PURPOSE: To explore the attitudes and skills related to parent-child shared reading before and after an intervention program conducted in a nursery room and outpatient pediatric clinic. METHODS: A single-group pretest-posttest quasi-experimental design was conducted. Seventy-five parents of newborns in the baby rooms from two hospitals in Hualien County were conveniently sampled. Parents who had just given birth received health education before discharge from the hospital from nurses focusing on the knowledge and skills of shared reading. Three age-matched picture books with reading fact sheets and consultation support were offered free to parents of children in three, respective, age groups (newborn, 4-months old and 6-months old) during parent-child visits to the pediatric clinic for regular health examinations and vaccinations. A self-designed questionnaire was administered to analyze the parents' demographic variables, reading environment, parents' attitudes toward parent-child shared reading, and familiarity with regard to parent-child shared reading skills. RESULTS: Parent-child reading attitudes were positively correlated with skill familiarity (r = .39). The presence or absence of children's books at home, the parent-child relationship, and parental reading habits explained 32.0% of the variance in parent-child shared-reading attitudes (R2 = .32). The presence or absence of children's books at home and the presence or absence of a library card for the child explained 44.0% of the variation in familiarity with co-reading skills (R2 = .44). Parent-child shared reading attitude scores (t = -5.14, p < .001) and skill familiarity of parents (t = -7.52, p < .001) both increased significantly after the intervention program. CONCLUSIONS / IMPLICATIONS FOR PRACTICE: Parent-child shared reading educational intervention programs may be used to improve parental attitudes and skills related to parent-child shared reading.

Low and unequal use of outpatient health services in public primary health care facilities in southern Ethiopia: a facility-based cross-sectional study.

BACKGROUND: Outpatient department visits per individual for each year are one of the core indicators of healthcare delivery to assess accessibility or quality of services. In addition, this study aimed to assess health service utilisation and disease patterns in southern Ethiopia, by including the health authorities' suggestions to improve the services. No study has assessed this in Ethiopia previously. METHODS: An institution-based cross-sectional design study was done in 65 primary health care units in Dale and Wonsho districts, in Sidama region, for all patients visiting health facilities from 1 July 2017 to 30 June 2018. We estimated the utilisation rate as visits per person per year, the odds ratio for health use and proportions of diseases' diagnoses. The results of our study were presented to local health authorities, and their suggestions for improvements were incorporated into the analysis. RESULT: A total of 81,129 patients visited the health facilities. The annual outpatient health service utilisation was 0.18 (95% CI: 0.18-0.19) new visits per person per year. The health service utilisation rate per year for the rural population was lower than the urban utilisation by 91% (OR = 0.09; 95% CI: 0.08-0.09). Children in the age group of 5-14 years had lower odds of health service utilisation by 78% (OR = 0.22; 95% CI: 0.21-0.23), compared to children under 5 years of age. Females were four times (OR = 4.17; 95% CI: 4.09-4.25) more likely to utilise health services than males. Febrile illness constituted 17.9% (14,847 of 83,148) of the diagnoses in all age groups. Almost half of the febrile cases, 46.5% (3827 of 8233), were among children under 5 years of age. There were very few cases of non-communicable diseases diagnosed in the health facilities. The health authorities suggested improving diagnostic capacities at health centres, enhancing health professionals' skill and attitudes, and improving affordability and physical accessibility of the services. CONCLUSION: The health service utilisation rate was low in Sidama. The use of health services was lower among rural residents, men, children and elderly, and health post users. Improving the quality, affordability and accessibility of the health services, by involving responsible stakeholders could increase service usage.

Resuming outpatient services during COVID times: Our approach and experience at India's apex institute.

Healthcare services have been severely strained and stressed coping with the rising burden of COVID-19 patients. With the situation gradually worsening and the growing need to cater to Non-COVID patients, we ventured to reopen the OPDs. This was to be implemented in a staggered manner. The backbone to this endeavour was the specialised screening and sampling OPD for healthcare workers which had been earlier established. We would like to share our two-pronged approach in this unprecedented situation: establishment of a specialised screening and sampling clinic for healthcare workers and a high-volume "Influenza-like screening clinic" for the resumption of outpatient services.

Improving Arthroplasty Efficiency and Quality Through Concentrating Service Volume by Complexity: Surviving the Medicare Policy Changes.

We have an academic medical center (AMC), an associated community-based hospital (CBH) and several ambulatory care centers which are being prepared to provide same day discharge (SDD) total joint arthroplasty (TJA) and unicompartmental knee arthroplasty (UKA). The near-capacity AMC cared for medically and technically complicated TJA patients. The CBH wanted to increase volume, improve margins, and become a center of excellence with an efficient hospital outpatient department and SDD TJA experience. METHODS: We transitioned primary, uncomplicated TJA, UKA, and minimally invasive TJA to the CBH. Revision surgeries, patients with extensive comorbidities, and complex primaries were performed at the AMC. Protocols were developed to facilitate SDD UKA and total hip arthroplasty (THA) as well as rapid recovery protocols for total knee arthroplasty (TKA) at both hospitals. A protocol-based system was put in place to make both hospitals ready for the removal of TKA from the Inpatient-Only list to avoid Quality Improvement Organization and possible resultant Recovery Audit Contractor audits if referred after implementation. RESULTS: The CBH volume increased 36.7% (+239). AMC volume slightly decreased (-0.46%, -5) resulting in an increase in margin contribution for the system. CBH quality metrics (surgical site infections, length of stay, readmissions, and mortality) were improved. Surgeon satisfaction improved as their volume, efficiency, quality metrics, and finances were enhanced. Although CBH per case revenue was 80.3% and 74.4% of the AMC for THA and TKA, net margins were 3.6% and 18.8% higher for THA and TKA, respectively. Increased efficiency, lower hospital cost, and higher volume at the CBH allowed for an increase in revenue despite lower reimbursement per case. CONCLUSION: This strategy will help hospital systems improve net margins while improving patient care despite lower net revenue per TJA episode. These strategies will become increasingly important going forward with the transition of higher numbers of TJA patients to outpatient which will be subjected to further decreases in net revenue per patient.

A qualitative exploration of the experiences of doctors, nurses and pharmacists regarding medication management in outpatient setting.

AIM: To understand how the medications are managed by the multidisciplinary team and their suggestions for nursing management, and to develop a framework for safe medication management in hospital-based outpatient. BACKGROUND: More than 80% of hospital-based outpatient visits involve medication prescriptions, indicating the importance of safe medication management there. METHODS: This was a qualitative study with face-to-face interviews with physicians, nurses and pharmacists from 11 medical outpatient units. RESULTS: Four themes elicited were categorized as follows: unclear professional roles and functions in outpatient medication management; intertwined communications; moving from data to wisdom; and ambiguous culture of safety. The resulting model is a collaboration of physicians, nurses, pharmacists, and patients and families integrated with hospital administrative support and information technology in a culture of safety. CONCLUSIONS: Medication management in outpatient is critical but usually overlooked. Nursing leaders should develop a culture of safety and provide more support and training for nurses to provide comprehensive medication management for outpatients. IMPLICATIONS FOR NURSING MANAGEMENT: It is important to develop outpatient nurses' role and competence in managing patient medication safety. Nurses in management would benefit from applying the 'framework of efficient and safe medication management for outpatients' to assess and identify weak areas for improvement.

Examining the impact of video-based outpatient education on patient demand for a rheumatology CNS service.

BACKGROUND: Patient demand for education and access to the clinical nurse specialists (CNSs) during the rheumatology clinic at one hospital in Ireland was increasing. Alternative methods of providing patient education had to be examined. AIMS: To explore the efficacy of video-based outpatient education, and its impact on demand for the CNSs. METHODS: A video was produced to play in a rheumatology outpatient department. A representative sample of 240 patients (120 non-exposed and 120 exposed to the video) attending the clinic was selected to complete a questionnaire exploring the effect of the video. Data were analysed using chi-square tests with Yates' continuity correction. FINDINGS: Demand for the CNSs was six times higher in the non-exposed group compared with the exposed group (non-exposed: 25%, exposed: 4.8%) (χ2=15.7, P=0.00007), representing a significant decrease in resource demand. CONCLUSION: High-quality educational videos on view in the rheumatology outpatient department provide patients with information sufficient to meet their educational needs, thus releasing CNS resources.

Evaluation of pattern of bacterial contamination of outpatient department table surfaces in relation to cleaning and disinfection practices in a tertiary care hospital in Ahmedabad.

BACKGROUND: Outpatient department (OPD) table surfaces frequently touched by patients and health-care workers in hospitals harbor potential pathogens and may act as source of infectious agents. OBJECTIVES: This study aimed to determine the pattern of bacterial contamination of surfaces of OPD tables in relation to existing cleaning/disinfection practices. METHODS: The descriptive study was conducted during July 2018-September 2018. A total of 128 swabs were collected from 32 OPD table surfaces immediately after cleaning or disinfection and then at 30 min, 2 h, and 4 h interval after cleaning or disinfection. Type and concentration of cleaner or disinfectant, number of cleaning strokes on table, and time of last washing of cleaning cloth with detergent were also noted from each location. Isolation, identification, and antibiotic susceptibility testing of the isolates were performed by standard microbiological techniques. RESULTS: A total of 337 bacterial isolates were recovered from 126 samples. Multidrug resistant Staphylococci, Acinetobacter, Pseudomonas, Klebsiella, and Escherichia coli were isolated. The mean bacterial colony count increased with time (P < 0.0001). Hand rub use, cleaning of OPD table surfaces with disinfectant, and more number of strokes with cleaning cloth resulted in decrease in colony count of bacteria isolated. CONCLUSION: High bacterial contamination of frequently touched OPD table surfaces with variety of potential pathogens like Staphylococcus, Acinetobacter, Pseudomonas, Klebsiella, and E. coli was detected. Hand hygiene among health-care workers and regular and frequent cleaning and disinfection of OPD table surfaces are highly recommended to prevent cross-transmission.

Risky sexual behavior and associated factors among patients with bipolar disorders in Ethiopia.

BACKGROUND: People with bipolar disorder are highly vulnerable to risky sexual behaviors (RSBs). The magnitude of RSBs among bipolar disorders was not studied in our population. The present study aimed to explore the prevalence of RSBs and associated factors among patients with bipolar disorder. METHOD: An institution based cross-sectional study was conducted from 1 April to 30 May 2017 among people living with bipolar disorder at outpatient departments of Amanuel Mental Health Hospital, Addis Ababa. Systematic random sampling was used to select participants. Risky sexual behavior was defined as having sex with two or more sexual partners, having unprotected sexual intercourse, sex after alcohol consumption, exchanged money for sex in a previous 12 months. Data collection was conducted through face-to-face interview by a structured questionnaire adopted from behavioral surveillance survey. Binary logistic regression was conducted to identify factors associated with RSBs. RESULT: A total of 424 participants were enrolled in the study, giving overall response rate of 96%. About 223(52.6%) were males. The prevalence of risky sexual behavior was 49.1% among bipolar patients. Male patients (Adjusted Odds Ratio (AOR) =2.23,95% CI = 1.27,3.92), patients in age group of 18-24(AOR = 2.08,95% CI = 1.47,3.81),current manic phase of the illness (AOR = 2.3195% CI,1.24,4.32) and current alcohol drinking (AOR = 3.70,95% CI = 2.01,6.78) had significant association with RSB. CONCLUSION: Almost half of bipolar patients reported a risky sexual behavior. Current manic episode and the consumption of alcohol were independently associated with RSB. To reduce the burden of RSBs, mental health services which focuses on sexual behaviors of bipolar patients is required.

Efficacy of physician associate delivered virtual outpatient clinic.

PURPOSE: The capacity available to deliver outpatient surgical services is outweighed by the demand. Although additional investment is sometimes needed, better aligning resources, increasing operational efficiency and considering new processes all have a role in improving delivering these services. The purpose of this paper is to evaluate the safety of a physician associate (PA) delivered virtual outpatient department (VOPD) consultation service that was established in a General and Colorectal Surgery Department at an Irish teaching hospital. DESIGN/METHODOLOGY/APPROACH: A series of low-risk surgical patients were referred by senior surgeons to a PA delivered virtual clinic (VOPD). Medical records belonging to half the included patients were randomly selected for review by two doctors three months following discharge back to primary care to confirm appropriate standards of care and documentation and to audit any recorded adverse incidents or outcomes. FINDINGS: In total, 191 patients had been reviewed by the PA in the VOPD with 159 discharged directly back to primary care. Among the 95 medical records that were reviewed by the NCHDs, there were no recorded adverse incidents after discharge. Medical record keeping was deficient in 1 out of 95 reviewed cases. PRACTICAL IMPLICATIONS: Using a PA delivered VOPD consultation appears to have a role in following up patients who have undergone low-risk procedures irrespective of age or co-morbidity when selected appropriately. This may assist in reducing the demand on outpatient services by reducing unnecessary return visits, thereby increasing the capacity for new referrals. ORIGINALITY/VALUE: While there are reported examples to date of virtual clinics, these relate to services delivered by registered medical practitioners. Here, the authors demonstrate the acceptability of this model of care in an Irish population as delivered by a PA.

Requesting spinal MRIs effectively from primary care referrals.

OBJECTIVE: To define if MRI scans can accurately be requested based on information provided in the primary care referral and, therefore, streamline the patient journey. The demand for outpatient spinal appointments significantly exceeds our services' ability to provide efficient, high-quality patient care. Currently, magnetic resonance imaging (MRI) of the spine is requested following first consultation. METHODS: During routine vetting of primary care referral letters, three consultant spinal surgeons recorded how likely they thought each patient would be to have an MRI scan. Following the first consultation with the spinal service, the notes of each patient were reviewed to see if an MRI was requested. We measured the positive predictive value (PPV), negative predictive value (NPV), sensitivity and specificity of ordering MRI scans based on primary care referral letters. RESULTS: 149 patients were included [101 females, 48 males, mean age 49 (16-87)]. There were 125 routine, 21 urgent, and 3 'urgent-suspected cancer' referrals. The PPV of ordering MRIs before first consultation was 84%, NPV was 56% with the sensitivity and specificity being 82 and 59%, respectively. Ordering MRIs during initial vetting could shorten the patient journey with potential socioeconomic benefits. CONCLUSIONS: MRI scans can be effectively ordered based on the information provided by the primary care referral letter. Requesting MRI scans early in the patient journey can save considerable time, improve care, and deliver cost savings. These slides can be retrieved under Electronic Supplementary Material.