Dissatisfaction-considered waiting time prediction for outpatients with interpretable machine learning.

Long waiting time in outpatient departments is a crucial factor in patient dissatisfaction. We aim to analytically interpret the waiting times predicted by machine learning models and provide patients with an explanation of the expected waiting time. Here, underestimating waiting times can cause patient dissatisfaction, so preventing this in predictive models is necessary. To address this issue, we propose a framework considering dissatisfaction for estimating the waiting time in an outpatient department. In our framework, we leverage asymmetric loss functions to ensure robustness against underestimation. We also propose a dissatisfaction-aware asymmetric error score (DAES) to determine an appropriate model by considering the trade-off between underestimation and accuracy. Finally, Shapley additive explanation (SHAP) is applied to interpret the relationship trained by the model, enabling decision makers to use this information for improving outpatient service operations. We apply our framework in the endocrinology metabolism department and neurosurgery department in one of the largest hospitals in South Korea. The use of asymmetric functions prevents underestimation in the model, and with the proposed DAES, we can strike a balance in selecting the best model. By using SHAP, we can analytically interpret the waiting time in outpatient service (e.g., the length of the queue affects the waiting time the most) and provide explanations about the expected waiting time to patients. The proposed framework aids in improving operations, considering practical application in hospitals for real-time patient notification and minimizing patient dissatisfaction. Given the significance of managing hospital operations from the perspective of patients, this work is expected to contribute to operations improvement in health service practices.

An evaluation of outpatient service provision in the National Health Service in Great Britain: A freedom of information request.

RATIONALE: The National Health Service (NHS) Long Term Plan was published in January 2019. One of its objectives was restructuring outpatient services, as part of an Outpatient Transformation initiative. Monitoring of trusts' adherence to the objectives of the Long Term Plan is therefore required to benchmark progress against national objectives. AIMS AND OBJECTIVES: We aimed to explore whether outpatient transformation initiatives and phlebotomy services that are managed by outpatients are appropriately staffed and to evaluate trusts' adherence to the objectives outlined in the Long Term Plan. METHOD: A freedom of information (FOI) request was sent in January 2023 to 153 trusts across Great Britain (time span: 1 January 2022-31 December 2022). Parameters requested included number of outpatients seen/discharged, phlebotomy episodes, number of sites/wards covered by phlebotomy, target/actual did not attend (DNA) rates, time since inception of the outpatient transformation project (OTP), advice and refer (A&R) and patient-initiated follow-up (PIFU), phlebotomy and outpatient managerial establishment and use of electronic notes and patient portals. RESULTS: A total of 117 trusts (76.5%) provided responses to the FOI request. The mean number of new outpatients seen face-to-face was 185,810. Of 73 trusts reporting both actual and target DNA rates, 62 (84.9%) did not meet their DNA targets. The actual DNA rate was significantly greater than the target DNA rate across trusts (p < 0.001, mean: 8.8% vs. 6.5%, respectively). A total of 58 different electronic systems and 29 patient portals were utilised across trusts. Thirty-six trusts (30.3%) did not have an outpatient transformation project manager and 16 trusts (13.7%) did not initiate an OTP. With phlebotomy provision, the mean number of outpatient phlebotomy episodes was lower than inpatient episodes (83,383 vs. 91,020, respectively). CONCLUSION: There are deficiencies in current outpatient establishments that may hinder the achievement of objectives set in the NHS Long Term Plan. Changes at all levels of healthcare are required, with increased reliance on technologies and investment in support for transformation management.

Assessing usability of intelligent guidance chatbots in Chinese hospitals: Cross-sectional study.

Objective: This study aimed to assessing usability of intelligent guidance chatbots (IGCs) in Chinese hospitals. Methods: A cross-sectional study based on expert survey was conducted between August to December 2023. The survey assessed the usability of chatbots in 590 Chinese hospitals. One-way ANOVA was used to analyze the impact of the number of functions, human-like characteristics, number of outpatients, and staff size on the usability of the IGCs. Results: The results indicate that there are 273 (46.27%) hospitals scoring above 45 points. In terms of function development, 581(98.47%) hospitals have set the number of functions between 1 and 5. Besides, 350 hospitals have excellent function implementation, accounting for 59.32%. In terms of the IGC's human-like characteristic, 220 hospitals have both an avatar and a nickname. Results of One-way ANOVA show that, the number of functions(F = 202.667, P < 0.001), human-like characteristics(F = 372.29, P < 0.001), staff size(F = 9.846, P < 0.001), and the number of outpatients(F = 5.709, P = 0.004) have significant impact on the usability of hospital IGCs. Conclusions: This study found that the differences in the usability of hospital IGCs at various levels of the number of functions, human-like characteristics, number of outpatients, and staff size. These findings provide insights for deploying hospital IGCs and can inform improvements in patient's experience and adoption of chatbots.

Disproportionate increase in cannabis use among people with serious psychological distress and associations with psychiatric service use in the United States, 2009-2019.

BACKGROUND: Cannabis use is on the rise, but it is unclear how use is changing among individuals with serious psychological distress (SPD) compared to the general population as well as what associations this may have with mental health service use. METHODS: Retrospective cohort study using the National Survey on Drug Use and Health (NSDUH) 2009-19 public use files of 447,228 adults aged ≥ 18 years. Multivariable logistic regression and predictive margin methods were used to estimate linear time trends in any and greater-than-weekly levels of cannabis use by year and SPD status and rates of psychiatric hospitalization and outpatient mental health care. FINDINGS: Rates of any and weekly-plus cannabis use increased similarly among individuals with SPD compared to those without from 200 to 2014 but more rapidly in SPD every year from 2015 to 2019 (p < 0.001). Among individuals with SPD, no use was associated with a 4.2 % probability of psychiatric hospitalization, significantly less than less-than-weekly (5.0 %, p = 0.037) and weekly-plus cannabis use (5.1 %, p = 0.028). For outpatient mental health care, no use was associated with a 27.4 % probability (95 % CI 26.7-28.1 %) of any outpatient care, significantly less than less than weekly use (32.6 % probability, p < 0.001) and weekly-plus use (29.9 % probability, p = 0.01). CONCLUSIONS: Cannabis use is increasing more rapidly among individuals with SPD than the general population, and is associated with increased rates of psychiatric hospitalization and outpatient service use. These findings can inform policy makers looking to tailor regulations on advertising for cannabis and develop public health messaging on cannabis use by people with mental illness.

Variables Associated with Quality of Life Among Individuals Living in Permanent Supportive Housing.

This study identified individual sociodemographic and clinical characteristics and service use patterns associated with quality of life (QoL) among 308 individuals living in permanent supportive housing (PSH) in Québec (Canada). Data were collected between 2020 and 2022, and linear multivariate analyses produced. Results demonstrated that better individual psychosocial conditions were positively associated with higher QoL. As well, living in PSH located in good neighborhoods for at least 5 years, higher self-esteem and community integration were positively associated with greater QoL. Met needs, satisfaction with housing support services, and no use of acute care were also linked with positive QoL. Comprehensive efforts to improve treatment for mental health disabilities responsive to the needs of PSH residents, and sustained long-term housing may reinforce QoL. Encouraging active participation in community-based activities, incorporating biophilic design into the neighborhoods around PSH, and promoting satisfaction with care may also enhance QoL.

[Usefulness of Pharmacist Outpatient Services for Inflammatory Bowel Disease].

Inflammatory bowel disease (IBD) is an autoimmune disease that inflames the intestinal tract and reduces patient quality of life. In recent years, prescriptions of biologics and Janus kinase inhibitors have made outpatient pharmacists indispensable to clinics and hospitals. Therefore, we retrospectively investigated the effectiveness of immunopharmacist outpatient services in treating IBD. The survey spanned between January 2019 and December 2020 and included patients who had visited an IBD-specialized outpatient clinic. The endpoints were the number of pharmaceutical and accepted interventions, improvement rates, and cost-effectiveness of the pharmacist outpatient services. The definition of pharmaceutical intervention involves the pharmacist outpatient clinic, which refers to the number of prescription proposals made to doctors, and the dispensing room, which refers to the number of inquiries made to doctors. The survey included 139 patients, and 579 assessments were performed in the pharmacist outpatient clinic. Out of 352 pharmaceutical interventions by the outpatient pharmacist group, 341 (96.9%) were accepted by physicians. Similarly, out of 74 pharmaceutical interventions by the dispensing group, 54 (73.0%) were accepted by physicians (p<0.0001). The overall improvement rate of pharmaceutical interventions was 93.5%. The immunopharmacist outpatient clinic was found to be cost-effective, with an estimated value of 44068000 yen. In IBD outpatient services, clinical pharmacists and physicians are integral members of the medical care team and have a positive impact on drug treatment outcomes.

Profiles of quality of outpatient care use, associated sociodemographic and clinical characteristics, and adverse outcomes among patients with substance-related disorders.

BACKGROUND: This study identified patient profiles in terms of their quality of outpatient care use, associated sociodemographic and clinical characteristics, and adverse outcomes based on frequent emergency department (ED) use, hospitalization, and death from medical causes. METHODS: A cohort of 18,215 patients with substance-related disorders (SRD) recruited in addiction treatment centers was investigated using Quebec (Canada) health administrative databases. A latent class analysis was produced, identifying three profiles of quality of outpatient care use, while multinomial and logistic regressions tested associations with patient characteristics and adverse outcomes, respectively. RESULTS: Profile 1 patients (47% of the sample), labeled "Low outpatient service users", received low quality of care. They were mainly younger, materially and socially deprived men, some with a criminal history. They had more recent SRD, mainly polysubstance, and less mental disorders (MD) and chronic physical illnesses than other Profiles. Profile 2 patients (36%), labeled "Moderate outpatient service users", received high continuity and intensity of care by general practitioners (GP), while the diversity and regularity in their overall quality of outpatient service was moderate. Compared with Profile 1, they  were older, less likely to be unemployed or to live in semi-urban areas, and most had common MD and chronic physical illnesses. Profile 3 patients (17%), labeled "High outpatient service users", received more intensive psychiatric care and higher quality of outpatient care than other Profiles. Most Profile 3 patients lived alone or were single parents, and fewer lived in rural areas or had a history of homelessness, versus Profile 1 patients. They were strongly affected by MD, mostly serious MD and personality disorders. Compared with Profile 1, Profile 3 had more frequent ED use and hospitalizations, followed by Profile 2. No differences in death rates emerged among the profiles. CONCLUSIONS: Frequent ED use and hospitalization were strongly related to patient clinical and sociodemographic profiles, and the quality of outpatient services received to the severity of their conditions. Outreach strategies more responsive to patient needs may include motivational interventions and prevention of risky behaviors for Profile 1 patients, collaborative GP-psychiatrist care for Profile 2 patients, and GP care and intensive specialized treatment for Profile 3 patients.

The Effect of Mobile Payment on Payment Waiting Time for Outpatients With Medical Insurance: Historically Controlled Study.

BACKGROUND: Waiting for a long time to make payments in outpatient wards and long queues of insured patients at the checkout window are common in many hospitals across China. To alleviate the problem of long queues for payment, many hospitals in China have established various mobile apps that those without health insurance can use. However, medically insured outpatients are still required to pay manually at the checkout window. Therefore, it is urgent to use information technology to innovate and optimize the outpatient service process, implement mobile payment for medically insured outpatients, and shorten the waiting time for outpatients, especially in the context of the COVID-19 epidemic. Furthermore, smartphone-based mobile payment for outpatients with health insurance could be superior to on-site cashier billing. OBJECTIVE: This study aimed to investigate the impact of smartphone-based mobile payment in relation to different aspects, such as waiting time, satisfaction with patients' waiting time, payment experience, the proportion of those dissatisfied with payment, total outpatient satisfaction, and outpatient volume, and compare mobile payment with on-site payment. METHODS: This was a historically controlled study. This study analyzed the outpatients' waiting time to make a medical insurance payment, their satisfaction with the waiting time and payment experience, the proportion of those dissatisfied with payment, and the outpatient volume of patients at Guangzhou Women and Children's Medical Center 1 year before and after the implementation of mobile payment for medical insurance in January 2021. An independent sample 2-tailed t test was used to compare waiting time, satisfaction with waiting time, and overall satisfaction. Paired sample 2-tailed t test was used to compare monthly outpatient visits. The chi-square test was used to compare the percentages of patients dissatisfied with payment. RESULTS: After the implementation of mobile payment for medical insurance outpatients, the patients' payment waiting time was significantly shortened (mean 45.28, SD 10.35 min vs mean 1.02, SD 0.25 min; t9014=53.396; P<.001), and satisfaction with waiting time and payment experience were significantly improved (mean 82.08, SD 3.17 vs mean 90.36, SD 3.45; t9014=-118.65; P<.001). Dissatisfaction with payment significantly decreased (10.27%, SD 2.18% vs 1.19% vs SD 0.30%; P<.001). The total satisfaction of outpatients significantly improved (mean 86.91, SD 3.23 vs mean 89.98, SD 3.31; t9014=-44.57; P<.001), and the outpatient volume increased (248,105.58, SD 89,280.76 vs 303,194.75, SD 53,773.12; t11=2.414; P=.03). Furthermore, payment efficiency improved, and the number of the on-site cashiers substantially decreased. CONCLUSIONS: Mobile payment for health insurance significantly shortened patients' payment waiting time; improved patient satisfaction on waiting time and payment experience and overall satisfaction; reduced the proportion of patients who were dissatisfied with payment and the cashier at the hospital; and increased monthly outpatient volume. This approach was effective and thus worthy of promoting.

Patient's satisfaction in physiotherapy outpatient departments of Amhara regional comprehensive specialized hospitals, Ethiopia.

BACKGROUND: Satisfaction is basically the state of being gratified and act of fulfilling one's need or desires. Nowadays, evidence-based practice concept is prevailing and there has been a growing interest in the measurement of patient satisfaction in healthcare research. Patient satisfaction surveys provide several benefits for healthcare professionals. Assessing patient's satisfaction with physiotherapy service could generate knowledge that can utilized for improving or maintaining quality service. Although a wide coverage and high emphasis givens to patient satisfaction studies in developed counties, there are few research's done in Africa. This study aimed to assess satisfaction in physiotherapy service and identify predictors that affect satisfaction among patient treated in physiotherapy outpatient department. OBJECTIVES: To assess satisfaction in physiotherapy service and identify associated factors among patients in physiotherapy outpatient department in Amhara regional state comprehensive specialized hospitals. METHOD: Institution based cross-sectional study was conducted among physiotherapy outpatients from April to June 2021, at three selected Comprehensive specialized hospitals. Data were collected by interviewing participants using semi-structured questionnaire. Patient satisfaction was determined by using Medrisk tool. Data were analyzed by using descriptive statistics and bivariate and multivariable logistic regression method were used to identify predictor factors. RESULT: A total of 409 participants with a response rate of 95% were included in this study. The overall satisfaction among physiotherapy outpatient attendee was 50.1% with 95% CI (46.2-55.7). Pain level (AOR = 5.59 95%CI (2.58-12.1), longitudinal continuity of care (AOR = 3.02 95%CI (1.46-6.62) and self-rated health improvement (AOR = 3.76, 95% CI (1.78-7.94) were significantly associated factors. CONCLUSION: The overall satisfaction in this study were found to be low in Amhara regional state comprehensive specialized hospitals. pain level, self-rated health improvement and longitudinal continuity of care were significantly associated factors.

Sleep clinic service model with closed-loop management for insomnia.

Insomnia is a common medical condition associated with other psychological and physiological disorders, and may require long-term treatment and outpatient management. As such, it is critical that effective treatment and management is provided in clinical practice. This study introduces an innovative outpatient service model for patients with insomnia, which includes providing medical care before, during and after diagnosis in public hospital clinics, completing prescribed treatments at home and return visits. It is a digital health-based, patient-centred, collaborative care model with closed-loop management. The proposed management strategy may help achieve a balance between the efficiency and the quality of outpatient medical care for insomnia.

"It's a part of the patient": The experiences of patients with cancer undergoing home-based chemotherapy from patients' and nurses' perspectives.

Objective: Home-based chemotherapy is widely used and offers advantages in terms of patient-centeredness, hospital capacity, and cost-effectiveness. However, in practice, patients experience difficulties with self-management and handling the elastomeric infuser. In this study, we aimed to explore the experiences of patients undergoing home-based chemotherapy based on patients' and nurses' perspectives. Additionally, we aimed to identify patients' unmet needs. Methods: A qualitative descriptive study was conducted in a tertiary hospital in South Korea. Ten patients undergoing home-based chemotherapy and ten nurses with experience in home-based chemotherapy participated. Data were collected by using semi-structured individual interviews and analyzed by using inductive content analysis. Results: Four main categories were identified based on the interviews: (1) ambivalence regarding comfort vs. enduring the discomfort, (2) acceptance of the discomfort as a part of them, (3) the need for more precise, numerical measurements, and (4) the realization that they need similar hands-on care at home as in a hospital. Conclusions: Although patients were satisfied with home-based chemotherapy, they were enduring the difficulties they experienced at home alone. Nurses should make an effort to identify patient needs and devise tailored nursing interventions to improve their safety.

Parental satisfaction with an advanced audiology-led triage service in paediatric ENT outpatient clinics.

OBJECTIVE: The advanced audiology-led service is designed to triage and manage children who are referred to Ear Nose and Throat (ENT) outpatient services with middle ear or hearing concerns. This service has resulted in shorter waiting times for children to receive ENT treatment, and improved ENT capacity. The aim of this study was to explore parental satisfaction with the advanced audiology-led ENT service and to determine if there were cultural or process factors affecting satisfaction. DESIGN: Prospective cross-sectional study using a modified Visit-Specific Satisfaction Questionnaire (VSQ-9) survey. STUDY SAMPLE: One hundred and thirteen parents of children consecutively attending a first appointment in the advanced audiology-led service recruited between October 2016 and October 2017. RESULTS: There were a total of 100 valid responses (rate of 88.5%). The survey showed high levels of satisfaction. Satisfaction scores were significantly higher for items related to interactions with the audiologist compared to items related to waiting times. There were no differences in satisfaction across cultural groups. Parents were equally satisfied with the service whether their child was managed independently by the audiologist or required another appointment for medical input. CONCLUSIONS: The advanced audiology-led service had high levels of satisfaction from parents attending with their children.

Effects of perimenopausal one-day outpatient multidisciplinary model on the cognition of women to menopause hormone therapy / 中国药房

OBJECTIVE To evalu ate the effects of perimenopausal one-day outpatient multidisciplinary model on the cognition of women to menopause hormone therapy （MHT）. METHODS The perimenopausal one-day outpatient service opened by the Third Affiliated Hospital of Chongqing Medical University in 2017 was introduced ，which was participated by doctors ，pharmacists， nutritionists，music psychotherapists ，nurses and other multidisciplinary members to provide systematic ，all-round，humanistic and face-to-face group science popularization and education ，practical experience and Q&A for women in perimenopause or about to enter perimenopause （called“students”）. The students who participated in one-day outpatient service in 2020 were selected as the survey object ， and the questionnaire was CMEI2020KPYJ（ZAMM）00206] designed to analyze the understanding of perimenopausal syndrome，awareness rate of MHT ，willingness to use and concerns. RESULTS A total of 295 students completed the questionnaire. Compared with before participation ， after participated in one-day outpatient service ，the cognition level of the students were all improved significantly ，including perimenopausal age （96.61％ vs. 99.32％，P＝0.037），the importance of perimenopausal health care knowledge （91.19％ vs. 96.95％，P＜0.001），whether the perimenopausal syndrome needs treatment （88.47％ vs. 99.32％，P＜0.001），willingness to use MHT （70.59％ vs. 94.48％ ，P＜0.001），MHT treatment timing （60.50％ vs. 95.17％ ，P＜0.001），reducing the risk of cardiovascular disease （51.68％ vs. 96.55％ ，P＜0.001），delaying aging （69.75％ vs. 97.59％ ，P＜0.001），preventing osteoporosis（65.13％ vs. 97.59％），P＜0.001）；the medical staff were higher than the non-medical staff （P＜0.05）. Totally 90％ of the students said they had gained knowledge about the prevention and treatment of common diseases ，nutrition and guidance， psychological regulation guidance hormone therapy related knowledges and exercise methods ；the proportion of the students who were willing to use MHT for 1 to 5 years（31.09％ vs. 47.93％）increased significantly. The proportion of the students who concerned about the risk of thrombosis （60.24％ vs. 36.81％），weight gain （59.64％ vs. 14.84％）and life-long dependence （52.41％ vs. 18.13％）was significantly reduced ，but that of the students who concerned about cancer risk was not diminished. From 2017 to 2020，the utilization rate of MHT was increased from 2.22％ to 62.16％ in non-medical staff among the students. CONCLUSIONS The multidisciplinary model of perimenopausal one-day outpatient service can improve the awareness of MHT among perimenopausal women ，eliminate misunderstandings ，and increase the utilization rate of MHT.

Discussion and practice of high-quality development path of outpatient service in public hospitals / 中华医院管理杂志

Based on the documents issued by the General Office of the State Council, the authors took system innovation, technological innovation, mode innovation and management innovation as the general principles of development, took safety, effectiveness, patient centered, fairness, economy and timeliness as the goal of high-quality development of outpatient services, and combined the three attributes of " medical quality management path" to explore the improvement path and specific practice of high-quality development from three aspects of technical quality, service quality and management quality for reference of peers.

Recent Outpatient Services in General Internal Medicine: 6.4% of Symptomatic Patients Were Post-Acute COVID-19.

PURPOSE: It is important to understand how COVID-19 is affecting general outpatient services, since hospitals see a wide variety of patients. This study aimed to evaluate the incidence and clinical picture of COVID-19 in general outpatient services. Currently, the diagnosis of COVID-19 depends strongly on the results of polymerase chain reaction (PCR) assays. However, since the sensitivity of PCR tests for SARS-CoV-2 is not high enough to assure confidence. On the other hand, the SARS-CoV-2 antibody (Ab) test is highly sensitive after 2 weeks of symptom onset, and might complement the PCR test. Therefore, we measured Ab in addition to PCR to obtain a more accurate clinical profile of COVID-19, which might be helpful in building future practice strategies. PATIENTS: The study patients were those who visited our department for the first time between November 2020 and March 2021 and fulfilled the enrolment criteria. METHODS: All patients underwent total SARS-CoV-2 Ab testing, and PCR tests were performed in only some of them; patients were classified according to the performance of PCR tests for comparisons. RESULTS: Ninety-four patients who underwent Ab testing during the study period were eligible for study enrolment, and the PCR test was performed in 40 of them. Only one patient was diagnosed with acute stage COVID-19 based on a positive PCR test. Antibodies were positive in six (6.4%) of the 94 patients. Five of the six Ab-positive patients were negative for PCR, and the test was not performed in the sixth patient. All the six patients had prior symptoms suggestive of infection, and respiratory symptoms were more noticeable than fever. The Ab positivity rate was significantly higher than published data. CONCLUSION: COVID-19 is not rare in general outpatient services and can be missed based on PCR tests alone. The diagnosis should be made from a comprehensive perspective.

Effect and satisfaction of outpatient services by precision valuation reservation registration.

BACKGROUND: Due to improvements in living standards, people are now paying more attention to their health. In China, more patients choose to go to large or well-known hospitals, which leads to constant crowding of outpatient clinics in these hospitals. AIM: To establish precision valuation reservation registration aimed at shortening waiting time, improving patient experience and promoting the satisfaction of outpatients and medical staff. METHODS: On the basis of the implementation of a conventional appointment system, more reasonable time intervals were set for different doctors by evaluating the actual capacity of each doctor to receive patients, and appointment times were made more accurate through intervention. The change in consultation waiting time of patients was then compared. Correlations between the consultation waiting time of patients and the satisfaction of patients or satisfaction of medical staff were analyzed. RESULTS: After precision valuation reservation registration, the average consultation waiting time of patients reduced from 18.47 min to 10.11 min (t = 8.90, P < 0.001). The satisfaction score of patients increased from 91.33 to 96.27 (t = -8.62, P < 0.001), and the satisfaction score of medical staff increased from 90.51 to 96.04 (t = -10.50, P < 0.001). The consultation waiting time of patients was negatively correlated with their satisfaction scores (γ = -0.89, P < 0.001). The consultation waiting time of patients was also negatively correlated with medical staff satisfaction scores (γ = -0.96, P < 0.001). CONCLUSION: Precision valuation reservation registration significantly shortened outpatient waiting times and improve the satisfaction of not only patients but also medical staff. This approach played an important role in improving outpatient services, provided a model that is supported by relevant evidence and could continuously improve the quality of management. Precision valuation reservation registration is worth promoting and applying in the clinic.

Management of diabetes-related foot disease in the outpatient setting during the COVID-19 pandemic.

The use of telephone and/or video consultation in routine management of acute diabetes-related foot disease (DFD) before the coronavirus disease 2019 (COVID-19) pandemic at a tertiary hospital is unprecedented. In March 2020, the Diabetes Feet Australia (DFA) released a national guideline to inform DFD management during the COVID-19 pandemic. The present study aimed to describe the adherence to the DFA guideline of managing acute DFD using telephone and/or video consultation at a Western Australian tertiary hospital during this period. We found >80% adherence rate to the DFA guideline and the management of active DFD using telephone and/or video consultations was feasible and acceptable in carefully selected patients.

Utilisation of telehealth for outpatient diabetes management during COVID-19 pandemic: how did the patients fare?

BACKGROUND: During the Coronavirus disease 2019 (COVID-19) pandemic, many outpatient services at public hospitals, including diabetes services, had adopted telehealth appointments for their clinic patients. There was concern that patients' glycaemic control may worsen during the pandemic. AIM: To assess glycaemic control of patients with diabetes attending telehealth consultations in 2020, compared to face-to-face reviews prior to pandemic. METHODS: We conducted a retrospective review of patients with diabetes managed by telehealth consultations over 5 months at two metropolitan hospitals in Sydney. Their attendance rate, glycaemic control and unplanned admissions to hospital were assessed, and these were compared with the same period 12 months prior when patients were reviewed via face-to-face appointments. RESULTS: Between April and September 2020, the attendance rate for telehealth consultation at the diabetes services at the two hospitals was 88.9% (884 out of 994), which was higher than in 2019 (85.2%; 818 out of 959; P = 0.016) when patients attended via face-to-face appointments. Of the 629 patients reviewed via telehealth in 2020 and who had been with our service for over 12 months, glycaemic control was better in 2020 (HbA1c 7.8 ± 1.4% (62 ± 15 mmol/mol)) compared with 12 months earlier (8.2 ± 1.7% (66 ± 19 mmol/mol); P < 0.001). There was no difference in the number of unplanned admissions for this cohort in 2020 (n = 58; 9.2%) compared with 2019 (n = 75; 11.9%; P = 0.100). CONCLUSIONS: The present study showed that for patients with diabetes who received care via telehealth consultations during the COVID-19 lockdown, their glycaemic control was slightly better, and unplanned admission rates were not higher compared with those in the pre-COVID-19 period. Telehealth consultation offers an important care delivery option in the management of patients with diabetes under these circumstances.

"Without the need for a second visit" initiative improves patient satisfaction with updated services of outpatient clinics in China.

BACKGROUND: To implement the "without the need for a second visit" (WNASV) initiative in our hospital by optimizing the outpatient clinic services via an upgraded information system, in order to increase the quality of outpatient medical services and improve patients' satisfaction. METHODS: An Internet-based care delivery approach was developed and applied to improve the delivery of health care services, simplify the treatment process, and reduce patient waiting time. The patient waiting time and consultation time in the outpatient clinics of our hospital during the peak service intervals and the proportions of various payment methods for outpatient services during the period from May 2017 to September 2019 were retrospectively analyzed. Also, the patients' satisfaction with the outpatient process was surveyed. RESULTS: The waiting time for consultation was shortened from 32.25 min to 28.42 min; the consultation time was shortened from 6.52 min to 3.15 min; and the waiting time for payment decreased from 7.40 min to 4.31 min. The proportion of payment via a counter was reduced from 86.80 to 21.79%, the proportion of self-service payment increased from 9.99 to 16.05%, and the proportion of payment during a consultation increased from 3.21 to 61.91%. The scores of the patients' satisfaction with the outpatient services increased from an average of 89.10 points in 2017 to an average of 90.26 points in 2019. CONCLUSION: The continuous improvement of the service process markedly increases the efficiency of the outpatient services, and effectively improves patient's satisfaction with the outpatient process, this initiative thus deserves further application.

Establishment and practical effect of comprehensive clinical management for out patients with orthotopic new bladder based on doctor-nurse cooperation / 中国实用护理杂志

Objective:To build a comprehensive clinical management of outpatient with orthotopic neobladder based on doctor-nurse cooperation to provide overall service to patients.Methods:The comprehensive clinical management was established in October 2018, 32 patients were collected retrospectively from January 2009 to before the establishment of the clinic, and 14 patients were collected from the establishment of the clinic to January 2020. After the establishment of the clinic, the comprehensive management mode was adopted, including the medical team implementing management from the aspects of implementing doctor-patient joint decision-making, guiding patients to carry out pelvic floor muscle rehabilitation training, teaching family members to carry out new bladder irrigation, and establishing patients′ records. Before the establishment of the clinic, there was no specialized personnel for unified management, and the doctor for new bladder irrigation and so on.Results:The rate of complete urinary control in the 46 patients with orthotopic neobladder was 82.6%(38/46) in the day and 71.7%(33/46) in the night. The rates of complete urine control of patients in the day and night were 12/14 and 9/14 after the establishment of the clinic. The length of stay which was (13.36 ± 9.44) d, and feeding time which was (5.00 ± 2.11) d of the patients after the establishment of the clinic were both less than those of the patients before the establishment of the clinic, which were (17.28 ± 9.98) d and (5.78 ± 2.90) d, but the differences were not statistically significant ( t values were -1.247 and -0.905 respectively, both P>0.05). However, for diurnal and night-time urine control, the proportion of people with more than one diaper was better after the establishment of outpatient clinic than before. Conclusions:The establishment of the comprehensive clinical management meets the needs of patients with orthotopic neobladder, enables patients to get the function of continence and urination sooner, and contributes to improve the clinical outcome of patients.