RESUMO
BACKGROUND: The rate of patients not keeping their appointments at our children's hospital outpatient pediatric neurology clinic (no-shows) was high. We conducted a quality improvement project to reduce no-show rates and improve operational efficiency. Specifically, we aimed to decrease the new patient no-show mean rate from 7% to 4% at the main campus and from 17% to 12% at the south campus. METHODS: After reviewing the previous literature on this topic and institutional data, we used the simplified failure mode and effects analysis (sFMEA) to identify the key drivers. Of the patients at the main campus who failed to keep their appointment, 84% had not confirmed their appointment. Errors in inpatient/family contact information, limited use of the electronic patient portal, and miscommunication were other key drivers identified. Three Plan-Do-Study-Act (PDSA) cycles were completed over seven months. The key interventions we implemented were bidirectional text triage, telephone reminders, and promoting the use of the electronic patient portal. A run chart was used to assess the results of these interventions. RESULTS: A statistically significant shift was noted in the run chart for the median rate of no-shows, which declined from 7% to 4% at the main campus and 17% to 10% at the south campus. CONCLUSION: We were able to successfully reduce no-shows among new patients in the neurology clinic. The limitations of our study include unknown external factors, the potential impact of COVID-19, and the brief length of the study.
Assuntos
COVID-19 , Neurologia , Envio de Mensagens de Texto , Criança , Humanos , Agendamento de Consultas , Telefone , Sistemas de AlertaRESUMO
Tourette syndrome (TS) causes academic, social, emotional, physical, and functional problems. Most TS patients also have comorbid neuropsychological conditions. The purpose of this review is to provide updated information to the clinician about phenomenology, epidemiology, comorbidities, pathophysiology and management strategies for tics (a hallmark of TS) and TS. Recent findings suggest that TS is likely due to a combination of several different genes and environmental factors, with possible involvement of the cortical-basal ganglia-thalamocortical circuit and related multiple neurotransmitters. First-line management includes psychoeducation for families, patients, and school personnel, as well as behavioral therapy. Non-medicine treatment for tics is advancing to include younger children and increase access via remote service applications. Pharmacotherapy is used if appropriate and several new medicines are under investigation (e.g., Tetrabenazine, valbenazine, deutetrabenazine, ecopipam, cannabinoids). Deep brain stimulation and Mouthguard therapy can be used for children with intractable illness.
Assuntos
Síndrome de Tourette , Terapia Comportamental , Criança , Comorbidade , Emoções , Humanos , Síndrome de Tourette/diagnóstico , Síndrome de Tourette/epidemiologia , Síndrome de Tourette/terapia , ValinaAssuntos
Meningites Bacterianas/diagnóstico , Estado Epiléptico/etiologia , Infecções Estreptocócicas/diagnóstico , Streptococcus agalactiae/isolamento & purificação , Acidente Vascular Cerebral/etiologia , Humanos , Lactente , Masculino , Meningites Bacterianas/complicações , Infecções Estreptocócicas/complicaçõesAssuntos
Epilepsia Resistente a Medicamentos/cirurgia , Lobo Frontal/cirurgia , Estado Epiléptico/cirurgia , Epilepsia Resistente a Medicamentos/fisiopatologia , Eletroencefalografia , Lobo Frontal/fisiopatologia , Humanos , Recém-Nascido , Imageamento por Ressonância Magnética , Masculino , Estado Epiléptico/fisiopatologiaAssuntos
Encéfalo/diagnóstico por imagem , Neoplasias do Sistema Nervoso Central/diagnóstico por imagem , Linfoma/diagnóstico por imagem , Encéfalo/patologia , Neoplasias do Sistema Nervoso Central/patologia , Criança , Diagnóstico Diferencial , Humanos , Linfoma/patologia , Imageamento por Ressonância Magnética , MasculinoAssuntos
Paralisia Bulbar Progressiva/diagnóstico , Perda Auditiva Neurossensorial/diagnóstico , Hipotonia Muscular/diagnóstico , Debilidade Muscular/diagnóstico , Nistagmo Patológico/diagnóstico , Paralisia Bulbar Progressiva/genética , Paralisia Bulbar Progressiva/patologia , Paralisia Bulbar Progressiva/fisiopatologia , Pré-Escolar , Diagnóstico Diferencial , Progressão da Doença , Feminino , Perda Auditiva Neurossensorial/genética , Perda Auditiva Neurossensorial/patologia , Perda Auditiva Neurossensorial/fisiopatologia , Humanos , Masculino , Hipotonia Muscular/genética , Hipotonia Muscular/patologia , Hipotonia Muscular/fisiopatologia , Debilidade Muscular/genética , Debilidade Muscular/patologia , Debilidade Muscular/fisiopatologia , Músculo Esquelético/patologia , Nistagmo Patológico/genética , Nistagmo Patológico/patologia , Nistagmo Patológico/fisiopatologia , IrmãosAssuntos
Corpo Caloso/diagnóstico por imagem , Encefalite por Herpes Simples/imunologia , Encefalite por Herpes Simples/terapia , Herpes Simples/imunologia , Herpes Simples/terapia , Complicações Infecciosas na Gravidez/imunologia , Complicações Infecciosas na Gravidez/terapia , Encefalite por Herpes Simples/diagnóstico por imagem , Feminino , Herpes Simples/diagnóstico por imagem , Humanos , Recém-Nascido , Complicações Infecciosas na Gravidez/diagnóstico por imagemRESUMO
http://onlinelibrary.wiley.com/journal/10.1002/(ISSN)2330-1619/homepage/mdc312518-sup-v001.htm.
Assuntos
Luxação Congênita de Quadril , Pré-Escolar , Feminino , Luxação Congênita de Quadril/complicações , Luxação Congênita de Quadril/diagnóstico , Luxação Congênita de Quadril/etiologia , Luxação Congênita de Quadril/terapia , Humanos , Lactente , Recém-Nascido , Masculino , Triagem Neonatal , Fatores de RiscoRESUMO
OBJECTIVE: The objective of this study was to evaluate the understanding of adolescent patients regarding epilepsy. METHODS: The SAFETY (Safety, Awareness, and Familiarity regarding Epilepsy in Teenage Years) questionnaire (content validity index: 0.96, Flesch readability score: 66.6) was administered to 165 cognitively normal adolescents with epilepsy (85 females, mean age: 15.2 ± 1.6 years, range: 13-18 years). The first part of the questionnaire was devised to evaluate knowledge about epilepsy and antiepileptic medications (SAFETY-K: 7 questions). The second part queried lifestyle modifications and safety (SAFETY-S: 10 questions). Female participants answered 5 additional questions related to reproductive health (RH questionnaire). RESULTS: The correct response rate for the composite SAFETY questionnaire was 51.5%. The average rates of correct responses for the SAFETY-K and SAFETY-S questions were 47.9% and 53.9%, respectively. On univariate logistic regression analysis, factors which were significant predictors of correct responses included age (odds ratio: 1.8, C.I. = 1.3-2.4), race (Caucasian vs. African-American; odds ratio: 3.9, C.I. = 1.4-10.4), and employment of at least one parent in a professional occupation (odds ratio: 3.3, C.I. = 1.1-10.3). The correct response rate did not correlate with the duration of epilepsy, extent of seizure control, number of antiepileptic medications, parental educational, or (un)employment status. The mean rate of correct responses for the RH questions amongst teenage girls was 17.4%. CONCLUSIONS: There is lack of awareness about epilepsy and its associated lifestyle modifications in adolescents with epilepsy seen at our institution. This is especially true in young adolescents, African-American patients, and those whose parents are not employed in professional occupations. Teenage girls with epilepsy appear to have limited knowledge with respect to contraception and childbearing.