Reason for the VA Health Care System's Wait Time Problem

2016 ◽  
Author(s):  
George Ricci
Keyword(s):  
Health Care ◽  
Wait Time ◽  
Time Problem

45. Education at distance: Broadcasting ECG rounds to Southeastern Ontario (BESO Project). An innovative approach for teaching electrocardiography

2007 ◽  
Vol 30 (4) ◽  
pp. 51 ◽  
Author(s):  
A. Baranchuk ◽  
G. Dagnone ◽  
P. Fowler ◽  
M. N. Harrison ◽  
L. Lisnevskaia ◽  
...  
Keyword(s):  
Health Care ◽  
Real Time ◽  
Digital Signal ◽  
Teaching Methodology ◽  
Care Providers ◽  
Long Distance ◽  
Medicine Clerkship ◽  
Time Problem ◽  
The Impact ◽  
Ecg Interpretation

Electrocardiography (ECG) interpretation is an essential skill for physicians as well as for many other health care professionals. Continuing education is necessary to maintain these skills. The process of teaching and learning ECG interpretation is complex and involves both deductive mechanisms and recognition of patterns for different clinical situations (“pattern recognition”). The successful methodologies of interactive sessions and real time problem based learning have never been evaluated with a long distance education model. To evaluate the efficacy of broadcasting ECG rounds to different hospitals in the Southeastern Ontario region; to perform qualitative research to determine the impact of this methodology in developing and maintaining skills in ECG interpretation. ECG rounds are held weekly at Kingston General Hospital and will be transmitted live to Napanee, Belleville, Oshawa, Peterborough and Brockville. The teaching methodology is based on real ECG cases. The audience is invited to analyze the ECG case and the coordinator will introduce comments to guide the case through the proper algorithm. Final interpretation will be achieved emphasizing the deductive process and the relevance of each case. An evaluation will be filled out by each participant at the end of each session. Videoconferencing works through a vast array of internet LANs, WANs, ISDN phone lines, routers, switches, firewalls and Codecs (Coder/Decoder) and bridges. A videoconference Codec takes the analog audio and video signal codes and compresses it into a digital signal and transmits that digital signal to another Codec where the signal is decompressed and retranslated back into analog video and audio. This compression and decompression allows large amounts of data to be transferred across a network at close to real time (384 kbps with 30 frames of video per second). Videoconferencing communication works on voice activation so whichever site is speaking has the floor and is seen by all the participating sites. A continuous presence mode allows each site to have the same visual and audio involvement as the host site. A bridged multipoint can connect between 8 and 12 sites simultaneously. This innovative methodology for teaching ECG will facilitate access to developing and maintaining skills in ECG interpretation for a large number of health care providers. Bertsch TF, Callas PW, Rubin A. Effectiveness of lectures attended via interactive video conferencing versus in-person in preparing third-year internal medicine clerkship students for clinical practice examinations. Teach Learn Med 2007; 19(1):4-8. Yellowlees PM, Hogarth M, Hilty DM. The importance of distributed broadband networks to academic biomedical research and education programs. Acad Psychaitry 2006;30:451-455

scholarly journals Patient-centred method to evaluate the spatial accessibility of primary health care in a case study in Shanghai

2020 ◽  
Vol 26 (4) ◽  
pp. 344
Author(s):  
Xuechen Xiong ◽  
Li Luo
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Primary Health Care ◽  
Waiting Times ◽  
Care Facility ◽  
Wait Time ◽  
Spatial Accessibility ◽  
Quantitative Methodology ◽  
Time Cost ◽  
Primary Health

Quantitative methodology investigating medical resource accessibility does not incorporate patients’ feelings about the adequacy and fairness of primary health care (PHC). In this study we quantified the spatial accessibility of PHC from the patient perspective. The main obstacles regarding access to PHC services are: (1) distance from the medical facility; and (2) waiting times after reaching the facility. The total time cost to access PHC is calculated as the sum of the time cost to access the PHC facility and the time cost waiting to receive health care; the total time cost was used in this study to reflect the potential spatial accessibility (i.e. probable entry into the healthcare system) of PHC. In Shanghai, it took residents approximately 13min to reach the nearest primary care facility, with an approximate 23min wait time after arriving at the facility. Thus, the spatial accessibility of PHC in Shanghai is approximately 36min. The method of assessing the spatial accessibility of PHC from the perspective of patients is more explanatory and easier to interpret. In the case of Shanghai, the regional accessibility of PHC is much better than its regional availability. Relevant managers should focus on increasing the resource supply capacity of existing facilities providing primary care in the suburbs of Shanghai.

scholarly journals P012: Why did you leave? Contacting left without being seen patients to understand their emergency department experience

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S61-S61
Author(s):  
B. Brar ◽  
J. Stempien ◽  
D. Goodridge
Keyword(s):  
Health Care ◽  
Wait Time ◽  
Wait Times ◽  
Average Wait Time ◽  
Left Without Being Seen ◽  
Care Processes ◽  
Time Period ◽  
Initial Interaction ◽  
Improving Health Care

Introduction: As experienced in Emergency Departments (EDs) across Canada, Saskatoon EDs have a percentage of patients that leave before being assessed by a physician. This Left Without Being Seen (LWBS) group is well documented and we follow the numbers closely as a marker of quality, what happens after they leave is not well documented. In Saskatoon EDs, if a CTAS 3 patient that has not been assessed by a physician decides to leave the physician working in the ED is notified. The ED physician will: try to talk to the patient and convince them to stay, can assess the patient immediately if required, or discuss other appropriate care options for the patient. In spite of this plan patients with a CTAS score of 3 or higher (more acute) still leave Saskatoon EDs without ever being seen by a physician. Our desire was to follow up with the LWBS patients and try to understand why they left the ED. Methods: Daily records from one of the three EDs in Saskatoon documenting patients with a CTAS of 3 or more acute who left before being seen by a physician were reviewed over an eight-month period. A nurse used a standardized questionnaire to call patients within a few days of their ED visit to ask why they left. If the patients declined to take part in the quality initiative the interaction ended, but if they agreed a series of questions was asked. These included: how long they waited, reasons why they left, if they went somewhere else for care and suggestions for improvement. Descriptive statistics were obtained and analyzed to answer the above questions. Results: We identified 322 LWBS patients in an eight-month time period as CTAS 3 or more acute. We were able to contact 41.6% of patients. The average wait time was 2 hours and 18 minutes. The shortest wait time was 11 minutes, whereas the longest wait time was 8 hours and 39 minutes. It was found that 49.1% of patients went to another health care option (Medi-Clinic or another ED in Saskatoon) within 24hrs of leaving the ED. Long wait times were cited as the number one reason for leaving. Lack of better communication from triage staff regarding wait time expectations was cited as the top response for perceived roadblocks to care. Reducing wait times was cited as the number one improvement needed to increase the likelihood of staying. Conclusion: The Saskatoon ED LWBS patient population reports long wait times as the main reason for leaving. In order to improve the LWBS rates, improving communication and expectations regarding perceived wait times is necessary. The patient perception of the ED experience is largely intertwined with wait times, their initial interaction with triage staff, and how easily they navigate our very busy departments. Therefore, it is vital that we integrate the patient voice in future initiatives geared towards improving health care processes.

Measurement of the Relationship between Patient Wait Time and Patient Satisfaction at each Stage of an Appointment

2007 ◽  
Vol 51 (18) ◽  
pp. 1277-1279 ◽  
Author(s):  
Patricia R. DeLucia ◽  
Kerstan S. Mork ◽  
Tammy E. Ott ◽  
Eston T. Betts ◽  
Nushin S. Niroumand ◽  
...  
Keyword(s):  
Health Care ◽  
Patient Satisfaction ◽  
Cancer Treatment ◽  
Patient Outcomes ◽  
Care Facility ◽  
Health Care Facility ◽  
Wait Time ◽  
Treatment Compliance ◽  
Treatment Facility ◽  
The Relationship

Patient satisfaction is associated with self-reported treatment compliance and patient outcomes. One factor that influences patient satisfaction is wait time– how long a patient waits during a visit to a health care facility. Here, we measured the time spent at each component of a patient's visit to a cancer treatment facility and its correlation with patient satisfaction. Results suggest that reducing the total time of a patient's visit to a health care facility will improve not only patient satisfaction with how long the entire visit takes, but also satisfaction with other aspects of the visit not including waiting. Moreover, results suggest that the time spent in the examination room waiting for the doctor is highly associated with patient satisfaction with overall time spent during the entire visit. In short, our results suggest several ways to improve patient satisfaction at a cancer treatment facility. The implication is that such improvements will lead to greater treatment compliance and ultimately to better patient outcomes.

Analysis of the referral pattern and wait time for hip arthroscopy in a single payer publicly funded health care system

2019 ◽  
Vol 26 (1) ◽  
pp. 81-85 ◽  
Author(s):  
Massimo Petrera ◽  
Federico Yanez‐Siller ◽  
Daniel Whelan ◽  
Graeme Hoit ◽  
Maryam Mahjoob ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care System ◽  
Hip Arthroscopy ◽  
Wait Time ◽  
Publicly Funded ◽  
Referral Pattern ◽  
Single Payer ◽  
Care System

scholarly journals Patients’ Experiences and Priorities for Accessing Gastroenterology Care

2019 ◽  
Author(s):  
Jennifer J Telford ◽  
Gregory Rosenfeld ◽  
Swati Thakkar ◽  
Nick Bansback
Keyword(s):  
Health Care ◽  
Functional Impairment ◽  
Care Service ◽  
Health Care Service ◽  
Wait Time ◽  
Final Analysis ◽  
Clinical Indication ◽  
Physical And Mental Health ◽  
Functional Attributes ◽  
Canadian Association

Abstract Background Wait times for gastroenterology care in Canada exceed recommended benchmarks set by the Canadian Association of Gastroenterology wait-time consensus. Patient-centered prioritization tools may help improve efficiency. Methods We conducted a survey on gastroenterology outpatients assessing their experience with accessing care, global health status and health care service utilization while waiting for a gastroenterology appointment. Thematic analysis of survey results informed the questions for a discrete choice experiment (DCE). Three attributes included were the following: clinical indication, functional status and time already waiting, which the study patients considered when prioritizing hypothetical patients. The DCE was analyzed using a conditional logit model. Results One hundred seventy-three patients completed all questions and were included in the final analysis. Over 80% reported good or excellent physical and mental health with 11% utilizing health care resources while waiting; 14% had waited more than 25 weeks for their appointment. Seventy-seven per cent of the patients were satisfied or better with their experience. Eighty-one per cent of the patients agreed with a prioritization system. Patients would prioritize a patient with a potentially more severe diagnosis or functional impairment over a patient with a less severe diagnosis clinical or functional impairment who had been waiting longer. The most severe clinical attributes were prioritized over the most severe functional attributes. Conclusion Patients support a prioritization tool for access to gastroenterology care. DCE indicated that patients are willing to wait longer in order for those with more severe clinical or functional attributes to be seen earlier. The relative times patients are willing to wait could be used to create a prioritization model for outpatients referred to gastroenterology.

scholarly journals Point-of-care diagnostics: needs of African health care workers and their role combating global antimicrobial resistance

2019 ◽  
Vol 30 (4) ◽  
pp. 404-410
Author(s):  
Rosalind Parkes-Ratanshi ◽  
Ruth Kikonyogo ◽  
Yu-Hsiang Hsieh ◽  
Edith Nakku-Joloba ◽  
Yukari C Manabe ◽  
...  
Keyword(s):  
Health Care ◽  
Sexually Transmitted Infections ◽  
Health Care Workers ◽  
Response Rate ◽  
Point Of Care ◽  
Rapid Test ◽  
Wait Time ◽  
Sexually Transmitted ◽  
Care Workers ◽  
Email Survey

Point-of-care tests (POCTs) offer the opportunity for increased diagnostic capacity in resource-limited settings, where there is lack of electricity, technical capacity, reagents, and infrastructure. Understanding how POCTs are currently used and determining what health care workers (HCWs) need is key to development of appropriate tests. In 2016, we undertook an email survey of 7584 HCWs who had received training at the Infectious Diseases Institute, Uganda, in a wide variety of courses. HCWs were contacted up to three times and asked to complete the survey using Qualtrics software. Of 555 participants answering the survey (7.3% response rate), 62% completed. Ninety-one percent were from Uganda and 50.3% were male. The most commonly-used POCTs were pregnancy tests (74%), urine dipstick (71%), syphilis rapid test (66%), and Gram stain (41%). The majority (74%) practiced syndromic diagnosis for sexually transmitted infections/HIV. Lack of availability of POCTs, increased patient wait time, and lack of training were the leading barriers for POCT use. Increasing POCT availability and training could improve uptake of POCTs for sexually transmitted infections in Africa and decrease syndromic management. This could reduce overtreatment and slow the emergence of antibiotic resistance. This is the first published email survey of HCWs in Uganda; mechanisms to increase the response rate should be evaluated.

scholarly journals A comparative study of patient characteristics, opinions, and outcomes, for patients who leave the emergency department before medical assessment

CJEM ◽  
2016 ◽  
Vol 19 (5) ◽  
pp. 347-354 ◽  
Author(s):  
Jacqueline Fraser ◽  
Paul Atkinson ◽  
Audra Gedmintas ◽  
Michael Howlett ◽  
Rose McCloskey ◽  
...  
Keyword(s):  
Health Care ◽  
Emergency Department ◽  
Performance Indicator ◽  
Medical Condition ◽  
Demographic Data ◽  
Family Doctor ◽  
Wait Time ◽  
Wait Times ◽  
Control Group ◽  
Fisher Exact Test

AbstractObjectiveThe emergency department (ED) left-without-being-seen (LWBS) rate is a performance indicator, although there is limited knowledge about why people leave, or whether they seek alternate care. We studied characteristics of ED LWBS patients to determine factors associated with LWBS.MethodsWe collected demographic data on LWBS patients at two urban hospitals. Sequential LWBS patients were contacted and surveyed using a standardized telephone survey. A matched group of patients who did not leave were also surveyed. Data were analysed using the Fisher exact test, chi-square test, and student t-test.ResultsThe LWBS group (n=1508) and control group (n=1504) were matched for sex, triage category, recorded wait times, employment and education, and having a family physician. LWBS patients were younger, more likely to present in the evening or at night, and lived closer to the hospital. A long wait time was the most cited reason for leaving (79%); concern about medical condition was the most common reason for staying (96%). Top responses for improved likelihood of waiting were shorter wait times (LWBS, 66%; control, 31%) and more information on wait times (41%; 23%). A majority in both groups felt that their condition was a true emergency (63%; 72%). LWBS patients were more likely to seek further health care (63% v. 28%; p<0.001) and sooner (median time 1 day v. 2-4 days; p=0.002). Among patients who felt that their condition was not a true emergency, the top reason for ED attendance was the inability to see their family doctor (62% in both groups).ConclusionLWBS patients had similar opinions, experiences, and expectations as control patients. The main reason for LWBS was waiting longer than expected. LWBS patients were more likely to seek further health care, and did so sooner. Patients wait because of concern about their health problem. Shorter wait times and improved communication may reduce the LWBS rate.

scholarly journals Measurement of surgical wait times in a universal health care system

2008 ◽  
Vol 2 (6) ◽  
pp. 597 ◽  
Author(s):  
Jun Kawakami ◽  
Wilma M. Hopman ◽  
Rachael Smith-Tryon ◽  
D. Robert Siemens
Keyword(s):  
Health Care ◽  
Multivariate Analysis ◽  
Real Time ◽  
Access To Health Care ◽  
A Priori ◽  
Wait Time ◽  
Administrative Databases ◽  
Wait Times ◽  
Data Set ◽  
Care Indicator

Introduction: Reported increases in surgical wait times for cancer have intensified the focus on this quality of health care indicator and have created a very public, concerted effort by providers to decrease wait times for cancer surgeryin Ontario. Delays in access to health care are multifactorial and their measurement from existing administrative databases can lack pertinent detail. The purpose of our study was to use a real-time surgery-booking software program to examine surgical wait times at a single centre.Methods: The real-time wait list management system Axcess.Rx has been used exclusively by the department of urology at the Kingston General Hospital to book all nonemergency surgery for 4 years. We reviewed the length of time from the decision to perform surgery to the actual date of surgery for patients in our group urological practice. Variables thought to be potentially important in predicting wait time were also collected, including the surgeon’s assessment of urgency, the type of procedure (i.e., diagnostic, minor cancer, major cancer, minor benign, major benign), age and sex of the patient, inpatient versus outpatient status and year of surgery. Analysis was planned a priori to determine factors that affected wait time by using multivariate analysis to analyze variables that were significant in univariate analysis.Results: There were 960 operations for cancer and 1654 for benign conditions performed during the evaluation period. The overall mean wait time was 36 days for cancer and 47 days for benign conditions, respectively. The mean wait time for cancer surgery reached a nadir in 2004 at 29.9 days and subsequently increased every year, reaching 56 days in 2007. In comparison, benign surgery reached a nadir wait time of 33.7 days in 2004 and in 2007 reached 74 days at our institution. Multivariate analysis revealed that the year of surgery was still a significant predictor of wait time. Urgency score, type of procedure and inpatient versus outpatient status were also predictive of wait time.Conclusion: The application of a prospectively collected data set is an effective and important tool to measure and subsequently examine surgical wait times. This tool has been essential to the accurate assessment of the effect of resource allocation on wait times for priority and nonpriority surgical programs within a discipline. Such tools are necessary to more fully assess and follow wait times at an institution or across a region.

scholarly journals Effect of integrated community neurology on utilization, diagnostic testing, and access

2017 ◽  
Vol 7 (4) ◽  
pp. 306-315 ◽  
Author(s):  
Muhamad Y. Elrashidi ◽  
Lindsey M. Philpot ◽  
Nathan P. Young ◽  
Priya Ramar ◽  
Kristi M. Swanson ◽  
...  
Keyword(s):  
Health Care ◽  
Diagnostic Testing ◽  
Wait Time ◽  
Emergency Department Visits ◽  
Care Utilization ◽  
Control Group ◽  
Face To Face ◽  
Control Comparison ◽  
Care Models ◽  
Matched Case

AbstractBackground:The primary care medical home (PCMH) aims to promote delivery of high-value health care. However, growing demand for specialists due to increasingly older adults with complicated and chronic disease necessitates development of novel care models that efficiently incorporate specialty expertise while maintaining coordination and continuity with the PCMH. We describe the effect of a model of integrated community neurology (ICN) on health care utilization, diagnostic testing, and access.Methods:This is a retrospective, matched case-control comparison of patients referred to ICN for a face-to-face consultation over a 12-month period. The control group consisted of propensity score–matched patients referred to a non-colocated neurology practice during the study period. Administrative data were used to assess for diagnostic testing, visit utilization, and patient time to appointment.Results:From October 1, 2014, to September 30, 2015, we identified 459 patients evaluated by ICN for a face-to-face visit and 459 matched controls evaluated by the non-colocated neurology practice. The majority of patients were Caucasian and female. ICN patients had lower odds of EMGs ordered (adjusted odds ratio [OR] 0.64; 95% confidence interval [CI] 0.46–0.89; p = 0.009), MRI brain (adjusted OR 0.60; 95% CI 0.45–0.79; p = 0.0004), or subsequent referral to outpatient neurology (adjusted OR 0.62; 95% CI 0.47–0.83; p = 0.001). ICN was not associated with an increase in emergency department visits, hospitalizations, or appointment wait time.Conclusions:The ICN model in a PCMH has the potential to reduce diagnostic testing and utilization.

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