scholarly journals Physiotherapy-led triage clinic for low back pain

2009 ◽  
Vol 33 (4) ◽  
pp. 663 ◽  
Author(s):  
Megan S Blackburn ◽  
Cary Nall ◽  
Belinda Cary ◽  
Sallie M Cowan
Keyword(s):  
Public Hospital ◽  
Waiting Times ◽  
Orthopaedic Surgeon ◽  
Low Back ◽  
Orthopaedic Clinic ◽  
Face To Face ◽  
Conversion Rates ◽  
Tertiary Teaching ◽  
Tertiary Teaching Hospital ◽  
Outpatient Appointments

The aims of this study were to evaluate a physiotherapy-led triage clinic (PLTC) and investigate general practitioner satisfaction with the PLTC. A retrospective cohort study was undertaken from January to December 2005 at a Melbourne tertiary teaching hospital. Outcomes assessed included waiting times to first appointment, patient attendance and surgery conversion rates. Outcomes were compared with the hospital 2002 benchmark data. GP satisfaction was evaluated by a survey. One-hundred and five new patients attended the PLTC clinic during the evaluation period. Patients waited 9 weeks for a PLTC appointment compared with 26 weeks for the general orthopaedic clinic and 23 weeks for the spinal orthopaedic clinic. Sixty-seven percent of the patients triaged in the PLTC were discharged from the orthopaedic outpatient department without requiring an orthopaedic surgeon consultation. Referring GPs were at least as satisfied with the management of their patients through the PLTC as with usual management in the general orthopaedic clinic. A PLTC can significantly reduce waiting times for orthopaedic outpatient appointments in a public hospital. Many patients can be managed by these experienced physiotherapists and their GPs, without the need for face-to-face contact with an orthopaedic surgeon. Pilot results indicated that GPs whose patients are managed in this PLTC were satisfied with this model for their patients with low back conditions.

Hand hygiene practices amongst patients

2017 ◽  
Vol 13 (2) ◽  
Author(s):  
Ashita Prasad ◽  
Harrison Ng Chok ◽  
Lesley Wilkes
Keyword(s):  
Hand Hygiene ◽  
Hospital Setting ◽  
Point Of View ◽  
Further Training ◽  
Face To Face ◽  
Patient Interviews ◽  
Hygiene Practices ◽  
Tertiary Teaching ◽  
Tertiary Teaching Hospital ◽  
Hygiene Compliance

Hand hygiene is seen as one of the principal means of preventing hospital based infections for both staff and patients. While there are many guidelines for hand hygiene practices for health professionals, there is a scarcity of research studies about the attitudes and hand hygiene practices among patients. The aim of this study is to explore nurses and patient attitudes and behaviours towards patient hand hygiene at a tertiary teaching hospital in Western Sydney. This descriptive study used patient observations of hand hygiene practices using a validated observation tool; face-to-face interviews with patients and a survey of nurses. Interviews and surveys were textually and quantitatively analysed. A total of 105 patient observations, 50 patient interviews and 51 nurse surveys were collected. The majority of patients and nurses respectively reported hand hygiene as an important aspect of everyday life in preventing infection in the hospital setting. However, this contrasts with the poor patient hand hygiene compliance identified using the patient observation tool. Patient interviews found that more encouragement and education by staff, increased signage and easily accessible facilities will increase hand hygiene practices. This study highlights the importance of patient input in understanding the entirety of hand hygiene practice from both the nurses and patients point of view. Further training of nursing staff in promoting a hand hygiene friendly environment will have a powerful influence among patients and in delivering patient centred care.

scholarly journals 2072. Do ID and Non-ID Clinicians Agree on IV to PO Switch Criteria? Results from Phase I of the INForming IV to ORal MEdication Report (INFORMER) Project

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S698-S699
Author(s):  
Rachael Bosma ◽  
Reem Haj ◽  
David Dai ◽  
Muhammad Mamdani ◽  
Michaelia Young ◽  
...  
Keyword(s):  
Initial Step ◽  
Eligibility Criteria ◽  
Convenience Sample ◽  
General Internal ◽  
Level Data ◽  
Conversion Rates ◽  
Tertiary Teaching ◽  
Tertiary Teaching Hospital ◽  
Antibiotic Dose ◽  
Clinical Stability

Abstract Background Converting intravenous (IV) antibiotics to an oral (PO) route is an important stewardship activity to reduce patient harm, including extravasation, thrombophlebitis, and catheter-related infections. The INFORMER Project aims to develop a “smart” electronic tool to streamline IV to PO conversion in eligible patients using an algorithm derived from patient-level data. In designing the algorithm, we noted significant clinician subjectivity in reviewing PO eligibility criteria. To support algorithm development and frontline clinician buy in for future e-tool use, an initial step of our project explored agreement level for IV to PO switch between general internal medicine (GIM) vs. ID clinicians. Methods A convenience sample of GIM patients (tertiary teaching hospital) were reviewed in a 4-month pilot. Patients were still on the ward and received a target IV antibiotic (fluoroquinolone, sulfamethoxazole/trimethoprim, clindamycin, metronidazole, linezolid, fluconazole, voriconazole, azithromycin). To mimic real-time decision-making, clinicians (MD and PharmDs) retrospectively assessed IV to PO eligibility of the last IV antibiotic dose on admission for (1) GI/absorption, (2) clinical stability and (3) global review (but not given specific thresholds/criteria). Agreement level was compared for ID vs. non-ID reviews. Results Overall, 52 patients’ IV to PO eligibility was assessed by multiple clinicians; 5 GIM teams and 6 ID MDs or PharmDs participated. ID vs. GIM respective assessment of Global eligibility was 61% vs. 48% (agreement in 71% of cases). ID vs. GIM assessment of acceptable absorption was 82% vs. 67%; acceptable clinical stability was 64% vs. 62% (Fig 1). Clinician comments were reviewed to identify algorithm improvements and areas for frontline education. Conclusion Our results are consistent with prior data suggesting up to 40–50% of patients may be eligible for IV to PO conversion, even at institutions that have IV to PO protocols. Our data also shows that overall, ID clinicians were more likely to assess a patient as ready for PO antibiotics vs. non-ID clinicians. Our findings are important as understanding cases of non-agreement and obtaining GIM consensus for tool utility are important for our next step, assessing INFORMER implementation on realtime IV to PO conversion rates. Disclosures All authors: No reported disclosures.

scholarly journals Impact and cost-effectiveness of formal gastroenterology outpatient referral Clinical Assessment Service

2017 ◽  
Vol 9 (2) ◽  
pp. 159-165 ◽  
Author(s):  
Stavroula Pelitari ◽  
Charlotte Hathaway ◽  
Dean Gritton ◽  
Andrea Smith ◽  
David Bush ◽  
...  
Keyword(s):  
Clinical Assessment ◽  
Waiting Times ◽  
Management Plan ◽  
Assessment Model ◽  
Health Economy ◽  
Information Platform ◽  
Face To Face ◽  
Clinical Benefits ◽  
Outpatient Appointments ◽  
To Receive

ObjectiveThe aim was to assess the financial and operational impact of our new gastroenterology referral pathway model on our services.DesignAn electronic ‘Clinical Assessment Service’ (CAS) proforma and an information platform were developed, and all data were analysed retrospectively.SettingRoyal Wolverhampton NHS Trust.Patients14 245 general practitioner (GP) referrals were received during January 2014–December 2016 with 9773 of them being triaged via our CAS.Main outcome measuresWe looked into patients’ clinical outcome along with departmental performance and finances.ResultsA new outpatient appointment was offered to 60.1% (n=5873) of the CAS referred patients. Endoscopic or radiological investigations were requested for 29.2% (n=2854) of patients prior to deciding on further management plan. Out of those, 27% (n=765) went on to receive another gastroenterology (GI) clinic appointment. The remaining 21.3% (n=2089) of the CAS patients were discharged back to their GP following initial investigations. 5.5% (n=538) were discharged back to primary care with a letter of advice, whereas 5.2% (n=509) were deemed inappropriate for GI clinic and were redirected to other specialists. Overall, 32% (n=3127) of patients were managed without a face to face consultation in the GI clinic. This corresponds to 3136 less outpatient appointments with estimated reduced expenditure by the Clinical Commissioning Group (CCG) of £481K. The 18-week performance and waiting times remained stable despite the increasing referral population. The DNA rate dropped from 14% pre to 8.5%.ConclusionsOur clinical assessment model has, in addition to the clinical benefits, a considerable positive financial impact to the health economy.

scholarly journals Evaluation of Emergency Health-Care Initiatives to Reduce Overcrowding in a Referral Medical Complex, Jeddah, Saudi Arabia

2021 ◽  
pp. 1-6
Author(s):  
Khalid Alabbasi ◽  
Estie Kruger ◽  
Marc Tennant
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Public Hospital ◽  
Waiting Times ◽  
Care Centre ◽  
Health Care Centre ◽  
Transfer Policy ◽  
Primary Health ◽  
Before And After ◽  
Ed Visits

<b><i>Purpose:</i></b> Excessive delays and emergency department (ED) overcrowding have become an increasingly major problem for public health worldwide. This study was to assess the key strategies adopted by an ED, at a public hospital in Jeddah, to reduce delays and streamline patient flow. <b><i>Materials and Methods:</i></b> This study was a service evaluation for a Saudi patient population of all age-groups who attended the ED of a public hospital for the period between June 2016 and July 2019. The Saudi initiative to reduce the ED visits at the King Abdullah Medical Complex hospital has started on August 7, 2018. The initiative was to apply an urgency transfer policy which outlines the procedures to follow when patients arrive to the ED where they are reviewed based on the Canadian Triage and Acuity Scale (CTAS). Patients with less-urgent conditions (category 4 and 5) are referred to a primary health-care practice (where a family medicine consultant is available). Patients with urgent conditions (category 1–3) are referred to a specialized health-care centre if the service is not currently provided. To test the effectiveness of ED initiative on reducing the overcrowd, data were categorized into before and after the initiative. The bivariate analysis χ<sup>2</sup> tests and 2 sample <i>t</i>-tests were run to explore the relationship of gender and age with dependent variable emergency. <b><i>Results:</i></b> A total of 233,998 patients were included in this study, 61.8% of them were males and the average age of ED patients were 35.5 ± 18.6 years. The majority of cases were those classified as “less urgent” (CTAS 4), which accounted for 65.4%. Number of ED visits before and after the initiative was 67 and 33%, respectively. ED waiting times after the initiative have statistically significantly decreased across all acuity levels compared to ED waiting times before the initiative. <b><i>Conclusion and Implication:</i></b> The findings suggest that the majority of patients arrive to the ED with less-urgent conditions and arrived by walking-in. The number of cases attending the ED significantly decreased following the introduction of the urgency transfer policy. Referral for less-urgent patients to primary health-care centre may be an important front-end operational strategy to relieve congestion.

Factors Impacting CTCA Quality in a Major Tertiary Teaching Hospital

2021 ◽  
Vol 30 ◽  
pp. S189
Author(s):  
I. Button ◽  
J. Bradley ◽  
R. Roberts-Thomson ◽  
B. Lorraine
Keyword(s):  
Teaching Hospital ◽  
Tertiary Teaching ◽  
Tertiary Teaching Hospital

Fatigue-management strategies among women with endometriosis in South Africa: a qualitative study

2021 ◽  
pp. 008124632110201
Author(s):  
Zamafiso Nombulelo Sibande ◽  
Rizwana Roomaney
Keyword(s):  
South Africa ◽  
South African ◽  
Psychosocial Intervention ◽  
Public Hospital ◽  
Management Strategies ◽  
Cognitive Strategies ◽  
Secondary Symptom ◽  
Face To Face ◽  
Fatigue Management ◽  
Insight Into

Fatigue is a common, secondary symptom of endometriosis that has not been qualitatively explored. We conducted individual, face-to-face interviews with 25 women in South Africa about their experiences of endometriosis-related fatigue. Participants were recruited at a public hospital in Cape Town and through several South African endometriosis organizations. Interviews were conducted in English and Afrikaans and ranged from 30 min to 1 hr 16 min in duration. All interviews were audio recorded and transcribed. Interviews were analyzed using thematic analysis. We found that both the experience of fatigue and fatigue-management strategies were highly personalized. Participants reported using a variety of cognitive strategies, such as planning, pacing, and pushing through their fatigue to reduce the levels of fatigue. Participants also employed physical strategies such as rest, dietary changes, using supplements, and exercise. We found that while participants often tried fatigue-management strategies suggested to them by others, they struggled to maintain these strategies even when they were successful. There are currently no interventions aimed at reducing endometriosis-related fatigue. The findings of this study provide insight into the management of fatigue in women with endometriosis and may be used to develop a psychosocial intervention for fatigue among women with the disease.

scholarly journals Using Technology to Promote Patient Engagement in Nutrition Care: A Feasibility Study

Nutrients ◽  
2021 ◽  
Vol 13 (2) ◽  
pp. 314
Author(s):  
Shelley Roberts ◽  
Wendy Chaboyer ◽  
Zane Hopper ◽  
Andrea P. Marshall
Keyword(s):  
Patient Satisfaction ◽  
Patient Engagement ◽  
Early Discharge ◽  
Nutritional Risk ◽  
Dietary Intakes ◽  
Intervention Delivery ◽  
Nutrition Care ◽  
Tertiary Teaching ◽  
Hospital Patients ◽  
Tertiary Teaching Hospital

Empowering patients to participate in nutrition care during hospitalisation may improve their dietary intakes and associated outcomes. This study tested the acceptability and feasibility of a technology-based intervention to engage hospital patients in nutrition care at a tertiary teaching hospital in Australia. The hospital used an electronic foodservice system (EFS), by which patients ordered meals via bedside computers. Adults at nutritional risk received the nutrition technology (NUTRI-TEC) intervention, involving nutrition assessment, education on nutrition requirements and training on using the EFS to enter food intakes and monitor nutrition goals. Acceptability was assessed using patient satisfaction and engagement surveys. Feasibility was assessed by evaluating the intervention delivery/fidelity and patient recruitment/retention. Patients’ dietary intakes were observed daily to indicate the intervention’s effects and assess the accuracy of the patient-recorded intakes. Descriptive and inferential statistics were used to analyse the data. Of the 71 patients recruited, 49 completed the study (55% male; median (IQR) age 71 (65–78) years; length of stay 10 (7–14) days). Patient satisfaction with NUTRI-TEC was high. Intervention delivery and fidelity targets were met but recruitment (≥50%) and retention (≥75%) targets were not; only 31% of patients agreed to participate and 69% completed the study (mostly due to unexpected/early discharge). Patient- and researcher-recorded dietary intakes correlated strongly, indicating patients can record food intakes accurately using technology. This study highlights the important role technology is likely to play in facilitating patient engagement and improving care during hospitalisation.

scholarly journals Overdose Rate of Drugs Requiring Renal Dose Adjustment: Data Analysis of 4 Years Prescriptions at a Tertiary Teaching Hospital

2008 ◽  
Vol 23 (4) ◽  
pp. 423-428 ◽  
Author(s):  
Seung Soo Sheen ◽  
Ji Eun Choi ◽  
Rae Woong Park ◽  
Eun Yub Kim ◽  
Young Ho Lee ◽  
...  
Keyword(s):  
Data Analysis ◽  
Teaching Hospital ◽  
Dose Adjustment ◽  
Tertiary Teaching ◽  
Tertiary Teaching Hospital

10 Years' Experience in Balanitis Xerotica Obliterans: A Single-Institution Study

2018 ◽  
Vol 29 (03) ◽  
pp. 302-306 ◽  
Author(s):  
Akhilesh Pradhan ◽  
Radhika Patel ◽  
A. Said ◽  
Manasvi Upadhyaya
Keyword(s):  
Average Duration ◽  
Age Group ◽  
Histological Findings ◽  
Single Institution ◽  
Exact Test ◽  
Balanitis Xerotica Obliterans ◽  
Tertiary Teaching ◽  
Tertiary Teaching Hospital ◽  
High Degree

Introduction Balanitis xerotica obliterans (BXO) is uncommon in children. Diagnosis of the condition is almost always clinical and supported by histology. Our aim was to evaluate the outcomes of children undergoing circumcision for BXO and explore the correlation between surgical and histological findings. Materials and Methods A 10-year retrospective review (2007–2017) of all children, aged 16 and less, undergoing circumcision at a tertiary teaching hospital was conducted. Statistical analysis was performed using Fisher's exact test. Results BXO occurred in 91/1025 (8.9%) children. The highest incidence of BXO was in the 5 to 10 age group (13.3%; p < 0.0001). The commonest symptom was foreskin scarring (62.6%). Intraoperatively, involvement of foreskin alone was seen in 26.4%, foreskin and meatus in 47.2%, and foreskin, meatus, and glans in 26.4%. Preoperatively, 24.2% of patients were prescribed steroid cream. Histologically, all patients showed microscopic changes confirming BXO. A total of 87.9% of patients only had a circumcision, and 11% required a meatal procedure along with the circumcision. Postoperatively, 19.8% of patients required a further procedure after an average duration of 5.8 months (range: 2–12 months); the majority of whom (83.3%) were prescribed postoperative steroid cream. Conclusion Clinical correlation by surgeons has a high degree of accuracy (>90%). Meatal involvement is more common than previously reported. The use of pre- or postoperative steroids does not obviate the need for further surgical procedures. Patients can have recurrent symptoms 1 year following surgery, and prolonged follow-up is necessary.

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