Open Appointment Research Articles

Teacher Hiring Processes in Private Educational Institutions: Methods, Qualifications, and Challenges

This research aims to comprehensively analyze the teacher recruitment process in private education institutions. The study utilizes a qualitative case study method, and data was gathered through semi-structured interviews with five administrators from boutique schools and five administrators from chain schools. The findings of the interviews revealed three main themes: "Methods for Teacher Hiring," "Desired Teacher Qualifications," and "Challenges." Interviews and course practices emerged as the primary methods for evaluating the personal and professional qualifications of potential teachers. Private school administrators emphasized the significance of personal, professional, and organizational qualifications in their recruitment processes. The research identified several difficulties faced during the teacher recruitment process, including teacher shortages, issues with loyalty, salary concerns, limited options, a lack of transparency, and teacher transfers. This information suggests that private school administrators may need to address these challenges to attract and retain qualified teachers effectively. To improve the recruitment of highly qualified teachers, it is recommended that private school administrators diversify their human resource management methods. Additionally, they should establish legal specifications for private school establishments, prioritizing educational goals over financial concerns. Collaboration between relevant institutions, such as the Council of Higher Education and the Ministry of National Education, is necessary for planning university teacher training quotas and open appointment processes, taking into account the needs of private schools.

Optimal adaptive neuro-fuzzy inference system with biogeography-based optimization for numbers of COVID-19 vaccination prediction

This study attempts to develop the adaptive neuro-fuzzy inference system (ANFIS) with biogeography-based optimization (BBO) (ANFIS-BBO) for a case study of the actual number of COVID-19 vaccinations in a medical center, considering the variables of the date and time of vaccination, the brand of vaccine, and the number of open appointments on the government network platform in Taiwan. The COVID-19 has brought about a great burden on the health and economy of the world since the end of 2019. Many scholars have proposed a prediction model for the number of confirmed cases and deaths. However, there is still a lack of research in the prediction model for mass vaccination. In this study, ANFIS-BBO is developed to predict the number of COVID-19 vaccination, and three other forecasting models, support vector machines (SVM), least-square support vector machines (LSSVM) and general regression neural network (GRNN) are employed for forecasting the same data sets. Empirical results show that the ANFIS-BBO with trapezoidal membership function model can achieve better performance than other methods and provide robust predictions for the actual number of COVID-19 mass vaccination.

FTP1.3 Woodcast is Ecologically Sound and Tolerated by Majority of Patients

Abstract Aim NHS England has set itself the task of delivering a “Net Zero” National Health service by 2040. It is incumbent upon all health care practitioners to work towards this goal. Orthopaedic surgeons are no exception. Distal radial fractures are the most common fractures sustained by the adult population. However, studies are shortcoming on individual patient experience. The aim of this study was to assess the patient’s satisfaction and outcomes with woodcast in the conservative management of distal radius fractures compared to the standard synthetic cast. Methods For all patients managed with woodcast in our unit, we undertook a structured questionnaire that included the The Oxford cast experience score, the numerical pain scale and qualitative open-ended questions about individual patient experience at the time of injury and six weeks after. Results 30 patients were initially managed with woodcast. 80% of patients tolerated woodcast for the full duration of their treatment. Of these, 20% didn’t tolerate woodcast and had their casts removed within 48 hours. Of the remaining, 79.1% were satisfied about woodcast comfort, 66% were very satisfied about woodcast weight, 70% were satisfied with temperature and sweatiness, 62.5% were very satisfied about the smell/odour, and 75% were satisfied about the level of support woodcast provided. During their treatment, 83.3% of patients rated their pain as five or less. Conclusions For those who completed their treatment in woodcast, none required any further intervention or utilised the open appointment because of ongoing wrist problems. In conclusion, when woodcast is tolerated, patients’ satisfaction and outcome levels were good.

Implementing Lean Six Sigma Concepts in Audiology Practices

Implementing Lean Six Sigma Concepts in Audiology Practices

Implementation of the Acute Care Clinic Easy Scheduling System at the Brooke Army Medical Center.

ABSTRACTIntroductionEmergency departments (EDs) have continued to struggle with overcrowding, causing delays in patient care and increasing stress on the medical staff and resources. This was further illustrated during the recent coronavirus disease 2019 pandemic, where we saw large unpredictable surges to the ED as hospitals tried to meet the medical needs of patients while trying to minimize the spread of coronavirus disease. A previous study from the Department of Emergency at the Brooke Army Medical Center (BAMC) found that nearly half of the patients presenting to the ED could have been managed in a primary care setting. We sought to pilot an alternate appointment scheduling system, Acute Care Clinic Easy Scheduling System, to allow patients to see and book available appointments while waiting in the ED waiting room.Materials and MethodsOur appointment display system was created through collaboration with the BAMC Information Management Division. A Tableau data interface connects to the Composite Health Care System to view available primary appointments across the San Antonio Military Health Care System. These are displayed in real-time on multiple TV screens outside the ED and in the ED waiting room. Patients were provided signage that provides a way to call or use a World Wide Web–based interface to immediately schedule the open appointments within the next 48 hours. Patients voluntarily opted to use this system and may opt to leave the ED if another appointment became available within an acceptable time frame to them.ResultsThis section is not applicable to this article.ConclusionsExpansion of the Acute Care Clinic Easy Scheduling System within the Military Health Care System may (1) help reduce ED crowding, (2) improve access to care through a live-tracking system that patients can review and select from, and (3) reduce the number of unfilled primary care appointments. The system in place in the BAMC ED serves as a template for other MTFs to use.

Family screening in brugada syndrome patients

Abstract Background Brugada syndrome (BS) is a rare inherited channelopathy associated with sudden cardiac death (SCD) and family screening (FS) of index patients (pts) is recommended. However, data about pts identified through FS is lacking. Aim To compare index pts to non-index pts identified through systematic FS. Methods Single-center retrospective study of BS pts followed by the Arrhythmology Department. FS was offered to 1st degree relatives of all index pts through primary care services and a once-weekly voluntary open appointment. Genetic counselling was performed when indicated. Index and non-index pts were compared regarding baseline characteristics and events during the follow-up (syncope of probable arrhythmic origin, ventricular tachycardia/ventricular fibrillation (VT/VF) and SCD). Results We included 165 pts (61% males, mean age 47±15 years) and 72 (44%) were identified through FS. Non-index pts were diagnosed at a younger age (42±14 vs 51±14 years, p <.001), were more often female (57% vs 25%, p<.001), were diagnosed predominantly through provocative test with ajmaline/flecainide (88% vs 47%, p<.001) and had less documented spontaneous type 1 ECG pattern (17% vs 59%, p<.001). A type 2 pattern was identified in 18 (25%) non-index pts. Genetic testing was performed in 38 (53%) non-index pts: 6 had a pathogenic SCN5A mutation, 18 a likely pathogenic SCN5A mutation and 12 a mutation of uncertain significance. At diagnosis, 24 (33%) non-index pts had history of syncope, 3 (4%) had nocturnal agonal respiration and 11 (15%) had palpitations with no differences between both groups (p=.119). Non-index pts were less likely to implant a cardioverterdefibrillator (14% vs 38%, p=.001). During a median follow-up of 28 (IQR 16–41) months, 10 (6%) pts had an event - 2 (3%) in the non-index group (2 syncope) and 8 (9%) in the index group (1 syncope; 7 VT/VF) - with no significative differences between groups (p=.432). There were nocardiovascular deaths. Conclusions FS identified a considerable proportion of BS pts. Non-index pts were younger at the time of the diagnosis and had less spontaneous type 1 pattern. No differences were found in events between index and non-index pts, however, the event rate was low. Systematic FS can identify individuals at risk of SCD earlier, allowing close monitoring and, when indicated, appropriate treatment. Funding Acknowledgement Type of funding sources: None.

633 Surveillance for Head and Neck Cancer Recurrences: Is There Scope for A Tailored Approach?

Abstract Introduction Detection of cancer recurrence after treatment of head and neck cancer (HaNC) is vital. Current guidelines stipulate that following primary treatment HaNC patients are followed up for five years with a total of 18-24 appointments. This forms a bulk of the HaNC surgeon’s workload. Asymptomatic recurrences are rare. Patients educated regarding worrying symptoms may institute their own follow up. Such open appointment systems may be as effective at detecting recurrences Method At a moderate volume HaNC centre we reviewed 98 patients that had completed their five year follow up. We investigated cancer recurrences and whether these were symptomatic or asymptomatic at time of detection. We analysed each recurrence regarding the time since primary treatment. Results 23 patients had HaNC recurrences. These recurrences were symptomatic in 17 patients and asymptomatic in 6 patients. Five of the six patients from the asymptomatic group had recurrences within two years of primary treatment. The final patient was of a high-risk histological subtype. Conclusions Asymptomatic cancer recurrences are uncommon especially after two years of regular follow up. After two years the frequency of appointments may be tailored on a patient-by-patient basis. Patients educated regarding symptoms of cancer recurrences may institute their own follow up.

Bone Tumours of the Talus: 18-Year Cohort of Patients With Rare Osteoid Lesions.

BackgroundBone tumours of the talus are a rare cause of ankle pain. This study aims to provide additional clinical clarity regarding the presentation and management of a minimally researched topic.MethodsSixteen patients were diagnosed with bone tumour of the talus between 2002 and 2020 following referral for ankle pain. Symptoms, diagnosis, and management were retrospectively reviewed. Patients were actively followed up until consistently symptom-free and consenting to discharge (mean of 2.9 years). An open appointment was offered to all patients to reattend the unit if symptoms recurred.ResultsThe most common diagnosis was osteoid osteoma/osteoblastoma (nine patients), chondroblastoma (four patients), a giant cell tumour of bone, a chondral lesion in Ollier’s disease and a rare metastatic renal cancer case. The mean age of onset was 29 years. Thirteen patients experienced ankle pain without a clear precipitating cause. Night pain was less common in osteoid osteoma/osteoblastoma than usually observed in the literature. The mean delay in diagnosis was two years, often due to an incorrect diagnosis of soft tissue injury. Plain radiographs are insufficient to identify most lesions.Ten patients underwent computed tomography (CT)-guided radiofrequency ablation and five patients had open surgical curettage. Ollier’s disease was managed with orthotics. The five cases of recurrence across four patients were managed operatively.ConclusionsPatients are usually young and healthy with benign disease, but talus tumours can cause significant functional impairment. Unexplained ankle pain should be extensively examined and be further investigated with magnetic resonance imaging (MRI) and CT scanning to avoid missing these rare tumours.

Offering disinclined people the choice between different screening appointments: a randomised online survey

Objectives An invitation to cancer screening with a single (fixed) appointment time has been shown to be a more effective way at increasing uptake compared with an invitation with an open (unscheduled) appointment. The present study tested whether offering more than one fixed appointment could further enhance this effect or be detrimental to people’s intention. Design Experimental online hypothetical vignette survey. Methods 1,908 respondents who stated that they did not intend to participate in Bowel Scope Screening (BSS) were offered either one, two, four or six hypothetical fixed BSS appointments (all of which covered the same time of day to control for individual preferences). Results Participants who were given more than one appointment to choose from were less likely to intend to book an appointment despite multiple appointments being perceived as more convenient. Conclusions These results suggest that when it comes to offering people appointments for cancer screening, less (choice) is more, at least if alternatives fail to serve an inherent preference.

Surgery Performed by Supervised Trainees Does not Affect Outcome in First Metatarsophalangeal Joint (MTPJ) Arthrodesis

First metatarsophalangeal joint (MTPJ) arthrodesis is an index procedure for orthopedic trainees in the United Kingdom. There is an absence of evidence as to the outcome of surgery when performed by supervised trainees. The aim of this study is to compare the incidence of fusion, complication rate and radiographic outcomes in first MTPJ arthrodesis performed by supervised orthopedic trainees with consultants. This is a retrospective cohort study of 117 patients undergoing first MTPJ arthrodesis from August 2015 to December 2017 in our institute for hallux valgus (HV) deformity with first MPTJ arthrosis or for hallux rigidus. Patients were followed to a minimum of 1-year postsurgery and were given an open appointment thereafter. In the hallux rigidus group, there was no significant difference between the complication rate (p = .477), incidence of fusion (p = .663), postoperatively HVA (p = .763), and postoperative intermetatarsal angle (p = .539) between trainees and consultants. There was a significant difference in mean tourniquet time (p = .563) between trainees and consultants. In the hallux valgus group, there was no significant difference in the complication rate (p = .519), incidence of fusion (p = .786), tourniquet time (p = .075), postoperative HVA (p = .423), and postoperative intermetatarsal angle (p = .143) between the trainees and consultants. This is the first MTPJ fusion series that demonstrates good results can be achieved by supervised trainees performing the procedure. This would suggest that first MTPJ arthrodesis remains an opportunity for trainees to continue learning to perform under supervision whilst ensuring no change in outcome for the patient.

ASE Statement on the Reintroduction of Echocardiographic Services during the COVID-19 Pandemic

• Echocardiography services have been interrupted by the COVID pandemic. • Services are being gradually reintroduced as healthcare facilities reopen. • Operational, workflow and prioritization considerations are suggested.

Evaluation of a pharmacist–physician covisit model in a family medicine practice

ObjectivesTo describe the financial implications, efficiency, and patient access to care with the use of a pharmacist–physician covisit model in a primary care practice. SettingA rural satellite practice of a large, teaching, multidisciplinary, family medicine organization. Practice descriptionMountain Area Health Education Center (MAHEC) is a large, multisite, family medicine teaching practice. Our site is a rural practice of MAHEC that serves western North Carolina. Practice innovationPharmacist–physician covisit model. EvaluationFourteen half-days of the covisit model from June 1, 2016, to January 31, 2017, were evaluated. Change in estimated clinic revenue was assessed for the physician only, separate pharmacist and physician visits, and the covisit model. Number and types of visits billed before and after implementation of the covisits were used to evaluate efficiency, and number of available appointments was used to evaluate patient access to care. ResultsCompared with physician billing alone, covisits generated an additional $4924.41 in 14 half-days or $158,291.04 over 1 year. Compared with separate visits, the covisit model increased estimated clinic revenue by $2757.89 over the 14 half-days and $88,646.47 over 1 year. During the pilot period of the covisit model, the pharmacist and physician combined billed a total of 189 visits, compared with 164 visits on matched days with separate visits. With covisits, more high-complexity codes and initial Medicare Annual Wellness Visits were billed. The physician was able to see an additional 1.3 patients per half-day in the covisit model compared with separate visits, and there was an average of 3.2 open physician appointments per half-day with covisits compared with 1.4 with separate visits. ConclusionCompared with both the physician-only and the separate-visit models, the covisit model is projected to substantially increase clinic revenue. In this model, more patients can be seen, higher-complexity visits are billed, and there are more available appointments.

PO652 Echocardiographic Mapping and Control of Rheumatic Heart Disease In Limited Resource Settings

To describe the financial implications, efficiency, and patient access to care with the use of a pharmacist–physician covisit model in a primary care practice.A rural satellite practice of a large, teaching, multidisciplinary, family medicine organization.Mountain Area Health Education Center (MAHEC) is a large, multisite, family medicine teaching practice. Our site is a rural practice of MAHEC that serves western North Carolina.Pharmacist–physician covisit model.Fourteen half-days of the covisit model from June 1, 2016, to January 31, 2017, were evaluated. Change in estimated clinic revenue was assessed for the physician only, separate pharmacist and physician visits, and the covisit model. Number and types of visits billed before and after implementation of the covisits were used to evaluate efficiency, and number of available appointments was used to evaluate patient access to care.Compared with physician billing alone, covisits generated an additional $4924.41 in 14 half-days or $158,291.04 over 1 year. Compared with separate visits, the covisit model increased estimated clinic revenue by $2757.89 over the 14 half-days and $88,646.47 over 1 year. During the pilot period of the covisit model, the pharmacist and physician combined billed a total of 189 visits, compared with 164 visits on matched days with separate visits. With covisits, more high-complexity codes and initial Medicare Annual Wellness Visits were billed. The physician was able to see an additional 1.3 patients per half-day in the covisit model compared with separate visits, and there was an average of 3.2 open physician appointments per half-day with covisits compared with 1.4 with separate visits.Compared with both the physician-only and the separate-visit models, the covisit model is projected to substantially increase clinic revenue. In this model, more patients can be seen, higher-complexity visits are billed, and there are more available appointments.

Current waiting times in a UK musculoskeletal general x-ray department

Patient waiting times are a key health policy concern worldwide; however, there is little literature investigating the impact of referral–examination waiting times in x-ray. This mixed-method study explores this issue in relation to waiting times in musculoskeletal primary care x-ray within a UK Trust, encompassing three hospital sites. Patient satisfaction levels are obtained, including their perceived maximum acceptable waiting time and choice of attendance time. Data were obtained via the Trust's Radiology Information System and through a patient survey which comprised of both closed and open questions. Survey results reveal an average waiting time of 12 days from referral to x-ray. Fifty-one percent of patients believed a maximum waiting period of 1 week or sooner would be the ideal. Template analysis was used to analyse the qualitative data and identified two key themes that influenced patient choice of appointment times. The first was ‘physical conditions’ including pain and illness, and the second ‘lifestyles’, including work, transport and carer availability. It is hoped that this data may be used to inform future UK studies regarding waiting time policy in x-ray. Locally, this study will form the basis of wider participatory action research towards implementing an open access appointments policy in x-ray.

What Are the Factors Influencing Implementation of Advanced Access in Family Medicine Units? A Cross-Case Comparison of Four Early Adopters in Quebec.

Introduction Advanced access is an organizational model that has shown promise in improving timely access to primary care. In Quebec, it has recently been introduced in several family medicine units (FMUs) with a teaching mission. The objectives of this paper are to analyze the principles of advanced access implemented in FMUs and to identify which factors influenced their implementation. Methods A multiple case study of four purposefully selected FMUs was conducted. Data included document analysis and 40 semistructured interviews with health professionals and staff. Cross-case comparison and thematic analysis were performed. Results Three out of four FMUs implemented the key principles of advanced access at various levels. One scheduling pattern was observed: 90% of open appointment slots over three- to four-week periods and 10% of prebooked appointments. Structural and organizational factors facilitated the implementation: training of staff to support change, collective leadership, and openness to change. Conversely, family physicians practicing in multiple clinical settings, lack of team resources, turnover of clerical staff, rotation of medical residents, and management capacity were reported as major barriers to implementing the model. Conclusion Our results call for multilevel implementation strategies to improve the design of the advanced access model in academic teaching settings.

Understanding clinician influences and patient perspectives on outpatient discharge decisions: a qualitative study

ObjectiveTo observe the influences on clinicians when discharging patients, to explore patients' perspectives concerning their discharge or follow-up decision and to identify what patients think is important for clinicians to...

Does the Proportion of Same-Day and 24-Hour Appointments Impact Patient Satisfaction?

The relationship between open access and patient satisfaction is mixed. Our study is the first to assess the relationship between open access appointment scheduling and patient satisfaction in the Military Health System (MHS). It is also unique in that we examine both same-day and 24-hour access through a relationship with satisfaction. We conducted a panel time-series analysis with general estimating equations on the Army population of outpatient facilities (N = 32), with 32 364 957 total observations. Our primary independent variables were the proportion of a facility's appointments within 24 hours and same day from July 2013 to May 2015. We identified that a higher proportion of same-day appointments is associated with increased patient satisfaction with the ability to see their provider when needed. We did not find the same result when examining access within 24 hours. Open access appointment scheduling appears to have a greater impact on patient satisfaction with timeliness of care if that appointment is made the same day the patient presents to the facility. Facilities should consider opening more of their schedule to accommodate same-day appointments. This can result in less costly primary care instead of emergency department usage.

Predictive overbooking and active recruitment increases uptake of endoscopy appointments among African American patients

Use of GI endoscopy is historically lower in nonwhite ethnic and racial groups compared with whites. These disparities are multifactorial but likely contribute to differences in GI clinical outcomes. We sought to improve endoscopy uptake overall and in minorities by predictive overbooking and active recruitment in a hospital-based GI clinic. From January to October 2014, we alternated between traditional booking for Veterans Affairs Healthcare Network patients with a physician recommendation for endoscopy and active recruitment of patients to fill projected open endoscopy appointment slots. On intervention weeks, patients attending a GI clinic were given the opportunity to "fast track" to an endoscopy appointment on short notice. During control weeks, patients were not actively recruited. We compared uptake of endoscopy appointments in both groups and performed logistic regression to determine predictors of participation in fast-track active recruitment. During fast-track active recruitment for endoscopy, the clinic recruited an additional 111 patients for endoscopy over passive recruitment, including 46 African Americans (41.4%). In a logistic regression model controlling for demographic and clinical characteristics, African Americans were twice as likely (adjusted OR, 1.99; 95% CI, 1.26-3.17) than whites to participate in the fast-track option for recommended endoscopy. Interventions to actively recruit patients for endoscopy increased the overall percentage of GI clinic patients undergoing endoscopy and disproportionately improved endoscopy appointment uptake in African Americans.

Reflections

Reflections

PTU-237 Band on the run: no follow up appointments required after rubber band ligation of haemorrhoids?

<h3>Introduction</h3> Several surgical options exist for the treatment of haemorrhoids, with rubber band ligation (RBL) being the commonest. Long term outcome data for RBL is sparse. We investigate the effectiveness of RBL haemorrhoids in the outpatient setting. <h3>Method</h3> Data for consecutive patients undergoing RBL of haemorrhoids between January 2013–January 2014 was collected retrospectively. Patients were followed up for a minimum of one year with specific data collected for previous treatments, proctoscopic appearances, and outcomes after RBL. <h3>Results</h3> Two hundred and sixty four patients [145 males, median age 52 years (range 19–94)] underwent RBL. In 177 this episode of RBL was their first intervention for haemorrhoids, with the remaining patients having previously had several different treatments including RBL (31%, n = 81), surgery (3%, n = 7) and sclerotherapy (&lt;1%, n = 1). Median time between previous treatments and RBL was 1 year (range 1 month- 30 years). The number of haemorrhoids was noted in 65% of patients (n = 177; solitary haemorrhoid 23% n = 40, multiple haemorrhoids 77% n = 137). Grade was recorded in 94/264: 1% Grade I (n = 11), 26% Grade II (n = 46), 19% Grade III (n = 33), 2% Grade IV (n = 4). Post RBL 88% (n = 231) of patients were offered 10 week open outpatient appointment as per local protocol, 11 patients (4%) were discharged and 22 (8%) were given specific dates for follow up (median 10 months (range 4–20 months)). 17% required further investigation: endoscopy in 16% (n = 44, where 37/44 were patients over the age of 50 years which follows local protocol for rectal bleed), defecating proctography in 2 patients and CT pneumocolon in 2 patients. At 1-year post RBL 72% (n = 192) of patients had not returned, but the remaining 72 were re-referred (mean time 8 months, standard deviation 154 days) with recurrent symptoms. Further treatment was with repeat RBL (n = 30) and surgery (n = 33), 1 patient referred to dermatology, one patient was referred to gastroenterology with proctitis. Seven patients returning to clinic either declined further banding or data was unavailable. <h3>Conclusion</h3> Patients presenting with haemorrhoids can be treated with RBL and then discharged (notwithstanding local protocols for exclusion of malignancy in patients over a certain age with PR bleeding). Three quarters will not return with further symptoms and the remainder will not represent for a year, so making planned follow up unnecessary. <h3>Disclosure of interest</h3> None Declared.