PATIENTS FOLLOW-UP APPOINTMENTS CRITERIA

OUT-lines

•Disadvantage of the current system.•Expectation of the new system.•Data collection procedures. •The Plan•summery

Disadvantage of the current system

• appointments beyond more than 3 months.

• Discrimination (Some patients have special handling or advantages than others specially in out patients clinics).

• Long time waiting.

• The waiting areas in the hospital are crowded.• don’t have water to drink .• posters or TVs to educate the patient.

• Appointments after long time sometime force the doctor to spend more time with the patients.

Looking forward to :-

•Increase the patients number seen in one day without affecting the quality of the care provided.

•Decrease the time wasted. No prolonged waiting time.

•Make sure that each patient have an enough time with the doctor.

•Organize the patients with numbers so each patient can predict the time that he will wait.

•Flexible system based on priority and decrease the mistakes and individual opinion .

The Questionnaire

•Self-developed questionnaire was distributed to patients in the waiting areas ,the participants were consented .

•The questionnaire was distributed in the (medical ,surgical ,ob/gyne , pediatric clinics)

•The patients questionnaire was divided into 2 parts before and after seeing the doctor.

•The sample was 107 patients and 28 doctors.

•the findings illustrates that57% of

the patients range form 23-50 yo and

30% of the patients educational level

was university.

•The most crowded clinic was by far

the medical clinic with 59% of the

patients.

57.9

<16 yo 18-23 yo 23-50 to>50 yo

•the findings illustrates that 57% of

the patients range form 23-50 yo and

30% of the patients educational level

was university.

•The most crowded clinic was by far

the medical clinic with 59% of the

patients.

medical

surgical

pediatric

ob/gyne

0

10

20

30

40

50

6059.2 percent of patients

percent of pa-tients

•70% of the patients with at

least a previous clinic visits (44%

>4 previous visits) .

•39% of the patient they follow

up after previous admission and

ER visit.

27%

16%

12%

45%

previous visit

0 1 2 >4

•70% of the patients with at

least a previous clinic visits (44%

>4 previous visits) .

•39% of the patient they follow

up after previous admission and

ER visit.

previous admission

previous ER visit

follow-up for Lap result

other resones

0%10%20%30%40%

17%

22%

33%

28%

Type of follow up

Series 1

For The Doctors :-

•55% of them expected to see more than 10 patients in the day.

•75% of doctors needed the consultation help around 1-3 times during the day.

•70% No specific way to divide the patients between the team.

•85% said that the hospital need more efficient system in the clinic.

Category 10

0.1

0.2

0.3

0.4

0.5

0.6

<5

7-10 p

55%

<5

5-7 p

7-10 p

>10

For The Doctors :-

•55% of them expected to see more than 10 patients in the day.

•75% of doctors needed the consultation help around 1-3 times during the day.

•70% No specific way to divide the patients between the team.

•85% said that the hospital need more efficient system in the clinic. How many time ...

0%

10%

20%

30%

40%

50%

60%

70%

80%

(1-3)

(3-6)

>6(1-3)

(3-6)

>6

For The Doctors :-

•55% of them expected to see more than 10 patients in the day.

•75% of doctors needed the consultation help around 1-3 times during the day.

•70% No specific way to divide the patients between the team.

•85% said that the hospital need more efficient system in the clinic.

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

no

yes

The problem is here

•46% of the patients had their previous appointment

before 2 months or more.

•46% of the patients were not sure that the same

doctor whose name was written in the appointment

paper is going to see them.

•40 % of the patients waited more than 1 hour , 28%

waited more than 2 hours.

previous visit w...

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

1 w2

w1 m

o

2 m

o or

mor

e

1 w

2 w

1 mo

2 mo or more

The problem is here

•46% of the patients had their previous appointment

before 2 months or more.

•46% of the patients were not sure that the same

doctor whose name was written in the appointment

paper is going to see them.

•40 % of the patients waited more than 1 hour , 28%

waited more than 2 hours.

waiting period until...

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

.5 h

1 h

> 2 h

.5 h

1 h

> 2 h

The problem is here

•90% of the patients didn't know when their

turn will come & for how long they will wait.

•43% of the patients has an appointment have

been delayed

•48% needed to get back to the doctor because

there is no appointments in the reception.

do you know when your turn ?

do you for how long you're going to wait ?

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

no yes

The problem is here

•90% of the patients didn't know when their

turn will come & for how long they will wait.

•43% of the patients has an appointment have

been delayed

•48% needed to get back to the doctor because

there is no appointments in the reception.

had one of your previous app...

difficulty in entering the ap...

0%

20%

40%

60%

80%

100%

no

yes

The plan

This plan depends on three parts to success :-• The medical team.• The administration.• The patient.

The Medical Team Part:-

Out-patient Classification System (OCS):-• This system categorize the patients

based on the severity of the case and how soon need to be seen.

• Distribute the patients upon the medical team according to their severity.

• Focusing of the hospital resources on patients with sever cases.

sever

III

a Delay cannot be tolerated if delayed ER or admission suspected

•Complicated cases.•Rare cases.•Need to know the lap result ASAP.•Risk with continuation on the same plan without follow up.•Red flags.•------------------------------------•Must be Seen by consultants.•SMS and call reminder.•Their lap should take the first priority.•Priority in the appointments.•Make their appointments at the beginning of the day•If it’s a chronic case with potential of >4 visit have to spend time with one of the administration staff or prepare paper clarify the hospital way in arrangement the appointments.•ID card show the patient case and possible red flag for admission.•1st Priorities in the pharmacy.•1st Priority in the radiology.

b if delay in the appointment happened the case will complicate .

c Sever stable case with complication need to be regularly followed up (end stage complication)

moderate

II a Cases most likely to present as sever case if delayed or get worse.

•Cases don’t meet any of the sever criteria.•Cases need to be seen >1 and <3 months.•Cases that the lap needs longer time to get the result.•Cases that continuing with same dose or stopping the drugs will not harm the patient.•Cases with complication that its semi-controlled or will not get complicated.-------------------------------------•Seen by a senior resident.•SMS reminder of the patient and the lap .

b Cases downgraded from sever after management or cases upgraded from mild that got complicated

mild I a Remission after treatment or need follow up after >6 month.

•Cases were treated.•Follow up after >6 months.•No complications.•Need laps after 6 months or more.•staple patient.------------------------------•Seen by a resident,

b Remission no further visit needed.

c staple patient need to do regular chick up for genetic or high risk in family.

First comer and referral

Sever:--Get the

investigation- seen by specialist

seen by the consultant

Moderate:--seen by the

resident

Not getting well or complicated

-upgrad

e to sever

Improveme

nt-

downgrade

Mild:-Seen by the

resident

Seen by

general clinic

1st visit

2nd visit

After ER or previous admission

Complicated or no

improvement- upgrade

Sever-

investigation should be

doneDetermine

the severity and

progression

Moderate-determine

the severity

and improvem

ent

Improvement-downgrade

mild

-considered (IIa)-investigation should be done

Determine the progress

1st visit

2nd visit-based on previous visit grading

Patient for follow up after >6 month

Determine the severity

Considered (Ia)

The Administration Part:-

•The hospital needs guidelines and protocols regard canceling and delaying the appointments of the patients.

•Ways enable the patient to communicate with hospital regard their appointments.

•patients need to be reminded by the hospital.

The Patient Part:-

• The patient should contact the hospital if he cant attend the appointment.

• The patient should confirm his presence in the hospital one hour before the appointment.

• If presence confirmation wasn’t approved the hospital may delay the patient appointment.

• Preparation 3-4 days before the visit:You should do your investigation the physician ordered.

Summary

Thank you