Medical outpatients: changes that can benefit patients

Abstract

-This article reviews the current literature relating to medical outpatient services. It has been produced as part of the RCP/NHS Confederation working party on outpatients departments. The article deals with surveys of patient views on outpatients, suggested ways of improving the service, and how best to accommodate teaching in this setting. An RCP booklet, 'How user friendly is your outpatient department?', has also been produced and is available from the college. KEY WORDS: ambulatory care, appointment, booking, clinic, outpatient, waiting timeMost physicians spend a significant part of their week working in the outpatient department but although the consultation in the outpatient clinic is an important part of patients' hospital care, it is traditionally an under-resourced area of the hospital. There has been little research into improving the service and, as a result, the experience for patients is not always as good as it should be.A well-run clinic will not only improve the experiences of patients but also the working lives of clinic staff. It may reduce the need for admission to hospital, both for disease control and for its investigation. 1 There is currently also political pressure for change, particularly regarding waiting times. The Government has recently issued a target of a maximum of three months wait for all outpatients' appointments by 2005. 2 This article reviews the literature relating to outpatients, with a focus on medical outpatients. The Working Party's aim was to develop recommendations to enable physicians to improve the experience for patients attending their clinics, and the work culminated in the publication of a booklet for health professionals. 3 Inevitably, in this paper there is some overlap with managerial issues (for example, direct booking systems or computer referral systems), and while some of these are beyond the scope of this article, they are addressed where physicians will be expected to work with managers to improve service delivery. Search strategyThe bibliographic databases Medline and Embase were searched for articles on outpatients, hospital outpatient clinics, outpatient departments or ambulatory care. Papers on day care were excluded. The results were limited to the UK, to the years 1966-2002 and to papers in English with abstracts available. Surveys of patient attitudes and satisfaction Waiting time and appointmentsLong waits for a first outpatient appointment are a common cause of patient dissatisfaction. However, one survey of a gastroenterology clinic showed that patients placed a similar value on waiting time for investigation and waiting for the first appointment: 4 a clinic that had a two-month wait for appointment, but offered immediate investigation was preferable to one with a two-week wait for appointment but a three-month wait for investigation. The authors suggest that to focus just on 'wait to first appointment' is too simplistic and does not take account of patient preferences.The length of time patients have to wait in the clinic before ...

An evaluation of patient attitudes to the gastroenterology outpatient experience

“…The role of the interactive factors in determining quality in the outpatient journey was also noted in a meta-analysis by Saila et al [30] that identified the importance of the consultation with the doctor, effective communication and the establishment of a trustful yet professional patientdoctor relationship. Our findings contrast with the results of studies that have placed an emphasis on process aspects of the outpatient journey including waiting times for a first appointment and in the waiting room [25] and time in consultation [35]. By comparison, published studies in oncology patients suggest that waiting times, environmental factors and aspects of patient-doctor interaction [36] may all be relevant to a satisfactory experience.…”

“…This included four domains from a qualitative assessment of patients' attitudes of the gastroenterology outpatient experience by two trained junior doctors using open questions, three domains from the national outpatient survey and a report of the key domains associated with satisfaction from the national outpatient survey [12] and three domains from a published, validated endoscopy-related patient evaluation [19,20]. These domains and a review of studies from the published literature [24][25][26][27] were used to identify aspects of the outpatient pathway that related to experiential quality. A composite, quantitative, self-completed patient questionnaire (Appendix 1) was then designed in two parts.…”

"Joining the dots" for patients with systemic lupus erythematosus: personal perspectives of health care from a qualitative study

“…Often they were seen by a registrar rather than the consultant, which is common practise within the British NHS. 24 However, the registrar was referred to as the ''understudy'' by one participant (Sophie), which underlines the women's feeling that they were not seen as important. Several of the participants noted that no-one seemed to be joining the dots and integrating their health care:…”

Organizational aspects to optimize patient's ambulatory pathway

“…management of waiting times is considered to be among the most important factors contributing to patient satisfaction [6,7]. A 1-h delay in the scheduled start time is associated with patients' complaints [8].…”