The outpatient multi-disciplinary team (MDT) model is an important measure to improve the quality of medical services and enhance patients’ medical experience. The Second Affiliated Hospital of Zhejiang University School of Medicine has explored three types of outpatient MDT models, namely specialized disease model, self-service model, and professor team model, in order to improve the accessibility and coverage of outpatient MDT. Through practice, it has been found that the implementation of multi-type outpatient MDT models can further leverage the advantages of MDT in society, hospitals, and patients. This article will share the experience of building multi-type outpatient multi-disciplinary team models mentioned above.
ObjectiveTo investigate the status of antibiotic drug use in the outpatient department based on the special rectification activities of antibiotic drugs, identify the reasons for irrational use of antibiotic agents and propose the solutions. MethodsPrescription of antibiotic drugs were analyzed by a retrospective comparative analysis during April to June 2011, August to October 2011 and August to October 2012. ResultsPrescriptions of antibiotic drugs were 435 (36.25%), 367 (30.58%) and 223 (18.58%) during April to June 2011, August to October 2011 and August to October 2012, respectively, and the unreasonable prescriptions were 35 (2.92%), 27 (2.25%), and 14 (1.25%) respectively. ConclusionThere is a decreased tendency of prescription of antibiotic drugs in the outpatient department of our hospital because of the special rectification activities of antibiotic drugs. It is in accordance with antibiotic use rate of <20% target of "antibiotics in 2012 special rectification program" in hospital outpatient service. But there are some unreasonable phenomena in the use of antibiotics, and to promote the reasonable use of antibiotics, we should strengthen management.
ObjectiveTo explore the function of information system platform in the management of outpatient registration source. MethodsOn the basis of registration appointment system, we surveyed again on outpatients traffic between February 6th and 10th in 2012 to find out find out the disadvantages of outpatient service procedures. Certain measures were taken for improvement, especially the management of registration source. ResultsAfter improvement by certain measures, queuing phenomenon and the degree of congestion in the waiting area were improved. To some extent, the satisfaction of patients and doctors was raised from 91% to 93%. ConclusionStandardizing outpatient administration and behavior of patients by information system platform has a good effect and is worth promoting.
Objective To provide baseline date for further research by retrospectively investigating the disease constitution of over-60-year old patients in the West China Hospital of Sichuan University in 2011. Methods The information of over-60-year old outpatients was extracted from HIS and their diagnoses were classified by ICD-10. The data of single disease among top 3 categories of diseases were rearranged and analyzed by Excel software. Results The total of over-60-year old outpatients was 895 123 person-time in 2011, accounting for 19.65%, including 716 826 person-time in specialist outpatient clinics. The specialist diagnoses of 683 491 person-time could be classified by ICD-10, accounting for 95.35% of specialist outpatients. The top 12 diseases were neoplasm, circulatory, digestive, factors influencing health status and contacting with health services, respiratory, musculoskeletal system and connective tissues, nervous, eyes, symptoms/signs and abnormal clinical and laboratory findings, non-classified, mental and behavioral disorders, endocrine, and genitourinary system diseases, and the cumulative constituent ratio was 92.96%. The main pathogenic sites of neoplasm were bronchus and lung (21.98%), esophagus (8.66%), stomach (8.10%), rectum (7.37%), prostate (5.86%), and liver and intrahepatic bile ducts (5.55%), with a cumulative constituent ratio of 57.72%. The main disease burden in circulatory system was hypertension (39.50%), chronic ischaemic heart disease (11.17%), and cerebral infarction (9.70%), and the cumulative constituent ratio was 60.38%. While the main disease burden in digestive system was gastritis and duodenitis (24.98%), other diseases of digestive system (9.26%), and other diseases of liver (8.90%), and the cumulative constituent ratio was 43.13%. There were more female than male among the over-60-year old outpatients (50.67% vs. 49.33%), and male was higher than female only in the incidence of neoplasm, respiratory, factors influencing health status and contacting with health services, and genitourinary system diseases. The disease constitution ratio of 60-69 years old patients was 58.21%. The top 3 neoplasm were the malignant tumors in digestive (38.20%), respiratory and intrathoracic organs (24.70%), and lymphoid, haematopoietic and related tissue (11.97%), with a cumulative constituent ratio of 74.87%. Conclusion The top 3 disease burden of over-60-year old outpatients in West China Hospital were neoplasm, circulatory and digestive diseases, which reflects the trend and law of treatment demands of old patients. It needs to deeply analyze the frequency and flow pattern of patients, and to provide evidence for preventing and treating geriatric diseases.
Patient safety culture is an extension of the concept of safety culture in medical institutions and is a hot spot of current patient safety research. In recent years, patient safety culture research has developed rapidly, and new assessment tools and related research have emerged. There is a correlation between cultural factors and safety outcomes, and changing the patient safety culture can improve patient outcomes. This paper focuses on the literature review of patient safety and outpatient safety assessment tools published in China and abroad, analyzes and compares the performance characteristics of domestic and foreign assessment tools, and provides reference for the future patient safety culture research.
Objective To verify the reliability and validity of a self-developed satisfaction evaluation questionnaire for outpatient department employees in public hospitals, and to provide suitable tools for conducting such surveys. Methods Two anonymous surveys were conducted on all employees of the Outpatient Department of West China Hospital of Sichuan University in July 2019 and November 2021, respectively. Questionnaire items were screened using methods such as item distribution, coefficient of variation, and decision value, and the reliability and validity of the questionnaire were evaluated using Spearman-Brown coefficient and Cronbach’s α coefficient, exploratory factor analysis, and confirmatory factor analysis. Results The final questionnaire retained 14 items, which could be divided into two dimensions: work conditions and interpersonal environment, and the overall fit index of structural equation model were as follows: χ2/ν=6.957, the standardized root mean square residual was 0.061, the root mean square error of approximation was 0.147, the goodness-of-fit index was 0.796, the adjusted goodness-of-fit index was 0.719, the normed fit index was 0.849, the relative fit index was 0.819, the incremental fit index was 0.868, the Tucker-Lewis Index was 0.841, and the comparative fit index was 0.867. The combined reliability of the two factors in the questionnaire was 0.94 and 0.91, respectively. The average variance extraction was 0.67 and 0.76, respectively, and the square root of the average variance extraction was 0.82 and 0.87, respectively, both of which were greater than the correlation coefficient of 0.71 between the two factors. The Spearman-Brown coefficient of the final questionnaire was 0.913, and the Cronbach’s α coefficients for the overall and two dimensions were 0.953, 0.937, and 0.910, respectively. Conclusion The reliability and validity of the satisfaction evaluation questionnaire for outpatient department employees in public hospitals are good and the questionnaire can be applied to practical surveys.
ObjectiveTo understand the situation of off-label use of aspirin among outpatients in Sun Yatsen Memorial Hospital, so as to provide baseline data for developing off-label drug use policy. MethodsA stratified random sampling method was used to collected prescription data of aspirin among outpatients in 2013. The incidence rates between different types of off-label use of aspirin were determined by chi-square test, and the influence factors of off-label drug use were analyzed by logistic regression model. ResultsA total of 5 023 prescriptions with aspirin were collected and analyzed, with incidence rate of off-label use up to 17.7%. The major category of off-label use was no indication (94.38%). The top 3 no indications were recurrent abortion, infertility and systemic lupus erythematosus. Drug specification, gender, age and prescribed department were the risk factors of off-label use. ConclusionAspirin off-label use is common among outpatients in Sun Yat-sen Memorial Hospital in 2013, especially in obstetrics and gynecology department and assisted reproductive center. The results suggest that more clinical studies about aspirin for reproduction are needed to provide more evidence of drug use, so as to ensure the safety of drug use in special populations and avoid potential medical risk.
After 5•12 When Chuan earthquake,The third hospital of Mianyang which is the nearest hospital of severely afflicted area recived 1 804 wounded persons.We aimed to summarize the achievement and limitation in management of medical rescue, medical treatment of the wounded and logistical support. Hospital shouled set up a special medical rescue system to relieve the sufferings of victims of unexpected natural calamities which include staff training, reserve supplies,psychological intervention of the wounded and safeguard of the rescuers.
Objective To optimize the environment of outpatient clinics in large hospitals, facilitate the patients’ visits and improve the comprehensive management level. Methods From September to November 2015, 2 hospitals in each part of a provincial city (middle, east, west, north and south), a total of 10 hospitals were chosed by convenient sampling method. The forms, types and distribution of outpatient navigation service system were investigated and analyzed by using a self-designed questionnaire. Results There were a total of 14 forms of counseling-guide services in the 10 hospitals. Just 1 hospital provided all the 14 forms of counseling-guide services, and 2 hospitals provided 13 forms of counseling-guide services, which were relatively complete. While the other 7 large hospitals provided only 4 to 6 forms of counseling-guide services, which were relatively simple. Conclusion Qualified outpatient navigation service system can help patients to receive more effective treatment, optimize the environment, highlighting the modern hospital humanistic service and the concept of intelligent service and scientific management.
Objective To assess the global situation of off-label drug use in outpatient children.Methods A search was conducted in PubMed, EMbase, CBM, CNKI and VIP for collecting studies on off-label drug use in outpatient children aged 0 to 18 years, and the publication language was limited to English and Chinese. The quality assessment was based on Crombie Criteria for cross-sectional studies, and the descriptive analysis was performed to analyze the incidence of off-label drug use at all levels of medical institutes and different age groups, the common types of off-label used drugs, and the constitution ratio of off-label use drugs. Results A total of 20 cross-sectional studies were included, involving 1 933 760 children and 5 262 573 prescriptions. The results of descriptive analysis showed: a) The incidence of off-label drug use in outpatient children in primary care and tertiary care institutes were 19.5% (IQR 13.5%, 24.5%) and 26.0% (IQR 24.0%, 35.0%), respectively; b) The primary studies reported that neonate, infant and adolescent had the highest incidence of off-label drug use, while the other children had the lowest incidence; c) Drugs for respiratory system, anti-infection, sensory organs, and dermatosis were listed as the top 5 frequently used off-label drugs by more than half of the studies; d) The studies with issue of “lack of instruction for children” showed it was exactly the type with highest incidence of off-label use, while other studies without that issue showed the highest incidence was over aged off-label use. Conclusion a) Off-label drug use is common in outpatient children. The incidence of off-label drug use may be higher in tertiary care institutes than primary care institutes, and it is higher in neonate, infant and adolescent rather than other age groups of children; b) Incidence of off-label use may be higher in inpatient children than outpatient ones; c) Drugs for respiratory system, anti-infection, sensory organs, and dermatosis were most common types of off-label use; and d) Off-label use due to both “lack of instruction for children” and “over aged use” is more common. So it suggests that further studies trials should focus on fields in which clinical trials of drugs are totally absent.