Patient Contact Time Research Articles

The role and scope of forensic clinical psychology in secure unit provisions: A proposed service model for psychological therapies

The purpose of this paper is to review the role and scope of forensic clinical psychology in forensic services and to develop a service model for psychological treatments in secure unit settings. The paper presents the findings of a one-year audit of the Southwark Forensic Psychology Service between April 2004 and March 2005, completed in order to determine the clinical activities provided by the service. It was found that 67% of working time was spent engaged in patient-related work (i.e., in direct or indirect patient contact), and an additional 11% in supervision of this work. The remainder of the time was spent in consultations and meetings, and in activities relating to recruitment, continuous professional development, research, teaching, and training. Only 19% of the patient-related work involved direct patient contact. Most of the indirect patient contact time related to attendance at management/ward rounds and care planning arrangement meetings, reading medical files, report writing, and conducting risk assessments. The audit findings have been used to produce a strength-based service model, which is based on current philosophy regarding the most effective way to integrate psychology into a multi-disciplinary team.

Agenda for Change and NHS reconfiguration

AbstractThe impact of Agenda for Change, NHS reconfiguration and financial restraints on diabetes health care professionals and specialist services is unknown. There has been considerable concern, however, that these initiatives have resulted in significant reductions in specialist diabetes services. The aim of this study was to investigate the effect of the recent NHS changes.Paper questionnaires were sent to 484 diabetes specialist nurses (DSNs) who were asked to complete the survey on behalf of their local multidisciplinary team and to 500 people with diabetes (user representatives [URs]).In all, 162 (33%) of the DSN questionnaires and 77 (15%) of the UR questionnaires were returned. Forty‐three percent of DSN respondents indicated that posts had been frozen, while 26% reported unfilled posts following maternity leave or retirement. Nine percent and 32% described redundancies and downgraded posts respectively. DSNs and paediatric DSNs were the staff groups most affected by budget cuts. Forty‐five percent identified reduced access to professional development and 40% reported denied requests for study leave. The impact on people with diabetes was significant, with 55% of DSN responders highlighting reductions in patient contact time and increased delays in patients' access to DSNs and consultants. Thirty‐four percent reported that specific diabetes services had been cut. Fifty percent of DSNs reported reductions in home‐based care and 49% reported decreases in patient education provision. These results were mirrored by the user representative survey.These findings indicate a major adverse effect of Agenda for Change and NHS reforms on the provision of diabetes specialist services and access to continuing professional development. Copyright © 2007 John Wiley & Sons.

Occupational Therapy for Children with Acquired Brain Injury: A Survey of Current Practice

This survey aimed to describe current occupational therapy practice for children with acquired brain injury in the Trent Region. Forty-three paediatric occupational therapists were sent questionnaires. Information was requested on referral patterns, amount of patient contact time, use of specific care pathways, assessments and the nature of interventions used, as well as contact with educational services. Eighteen therapists replied and their responses illustrated the difficulties involved in providing a service for this population. The therapists reported low referral rates, service pressures, difficulty in obtaining specialist paediatric equipment and inadequate training. It is suggested that services should provide and network with appropriate training for therapists, and continue the development of care pathways and outcome measures.

Service delivery trends for a physical rehabilitation outreach program

Purpose. Evaluate clinical service characteristics of a physical rehabilitation outreach clinic.Method. A retrospective analysis on service-related factors and patient information (every clinical encounter between 1983 and 2002) was performed on the Terry Fox Mobile Clinic. The Terry Fox Mobile Clinic provided multidisciplinary physical rehabilitation outreach services for adults with disabilities in Eastern and North Eastern Ontario, Canada (on-site visits by rehabilitation specialists). Subjects include 4816 clients with physical disabilities from Eastern and North Eastern Ontario, Canada. Patient data (age, residence, diagnosis, inpatient/outpatient), clinic data (type, location, totals), team data (clinical disciplines), and assistive device utilization over the last 15 years of data were used for analysis.Results. Over 15 years, 4816 clients (1032 clinic days, 1.46 patient-contact ratio) were seen by the outreach team. Single discipline days were the best ‘number of clinic days’ predictor. Following 1999, the 35 – 64 age group became predominate (instead of over-65). Most patients lived in their own residence. Stroke, amputations, neck and back pain, and cerebral palsy accounted for 53% of patient diagnoses. Wheelchairs and orthoses were the highest ranked assistive device consultations/prescriptions (total = 6304). Physicians were involved with the majority of patient contacts. Most clinic activity occurred at sites within 100 km driving distance. Sites over 200 km away had the lowest correlation with the number of clinic days.Conclusions. The 15 years of physical rehabilitation outreach service data is valuable for planning new outreach programs, benchmarking existing services, and telerehabilitation comparisons. Multidisciplinary physical rehabilitation can make a positive contribution to healthcare that extends beyond direct patient contact time.

Work-related musculoskeletal disorders: a survey of physical therapists in Izmir-Turkey.

BackgroundThis study was planned to collect data about causes, prevalence and responses to work-related musculoskeletal disorders reported by physiotherapists employed in Izmir, Turkey.MethodA two-page survey with closed ended questions was used as the data collected method. This survey was distributed to 205 physiotherapists working in Izmir, Turkey, and 120 physiotherapists answered. Questions included occupational history of physiotherapists and musculoskeletal symptoms, special areas, tasks, job-related risk factors, injury prevention strategies, and responses to injury.ResultsEighty-five percent of the physiotherapists have had a musculoskeletal injury once or more in their lifetime. Injuries have been occurred mostly in low back (26 %), hand-wrist (18 %), shoulders (14 %) and neck (12 %). The highest risk factor in causing the injury was transferring the patient at 15%. Sixty-nine percent of physiotherapists visited a physician for their injury and sixty-seven percent of the respondents indicated that they had not limited their patient contact time as a result to their injuryConclusionsAccording to the results of this study, the rate of musculoskeletal disorders in physiotherapists in Izmir-Turkey has been found to be high due to their profession. Respondents felt that a change in work habits was required in order to decrease the risk of another injury.

The ageing of the population: implications for multidisciplinary care in hospital

Comprehensive geriatric assessment and multidisciplinary intervention are of proven benefit in the care of older people. To determine whether patients' multidisciplinary needs in hospital can be met by current service provision. A comprehensive census assessing the multidisciplinary needs of an entire inpatient population compared to available multidisciplinary therapy time. A large teaching hospital Trust, comprising six hospital sites. On census day, the age, Barthel Index score and multidisciplinary needs of all adult inpatients were documented. Each therapist completed a questionnaire regarding their direct patient contact time on census day. 889 of 1,324 eligible patients (69%) had multidisciplinary needs on census day. These patients were scattered throughout all 46 acute wards, 14 rehabilitation and 4 continuing care settings. Mean age was 65.3 years in acute wards, 73.5 in rehabilitation wards and 80.8 in continuing care. Age correlated inversely with Barthel Index score (r -0.255, P <0.01). The percentage of patients with multidisciplinary need increased with increasing age. The calculated number of minutes of therapy time per day available to each patient varied between therapies and across sites. Mean physiotherapy time available per patient needing physiotherapy on census day ranged from 17 minutes 41 seconds in acute wards to 26 minutes 24 seconds in rehabilitation wards. A high proportion of inpatients, particularly older patients, across all care settings have multidisciplinary needs. This needs to be expressly considered in the planning of future health services if multidisciplinary needs of older people in hospital are to be met.

Are your patients getting the information they need?

In an era when physician–patient contact time is limited, but there are abundant information resources, physicians often assume that their patients are amply informed. The Internet is recognized as an important vehicle for obtaining medical information, although limitations regarding misinformation are well known. However, patients may not be using the Internet for health information as much as we think. Only 40% of respondents with Internet access used the Internet to look for information about health or health care in 2001.1 Thus, our patients often need to be guided to high-quality, credible online resources. Since July 2002, the Patient Page has been an online feature of Neurology . The Pages provide critical …

Patient problems, advanced practice nurse (APN) interventions, time and contacts among five patient groups.

To describe patient problems and APN interventions in each of five clinical trials and to establish links among patient problems, APN interventions, APN time and number of contacts, patient outcomes, and health care costs. Analysis of 333 interaction logs created by APNs during five randomized controlled trials: (a) very low birthweight infants (n = 39); (b) women with unplanned cesarean birth (n = 61), (c) high-risk pregnancy (n = 44), and (d) hysterectomy (n = 53); and (e) elders with cardiac medical and surgical diagnoses (n = 139). Logs containing recordings of all APN interactions with participants, APN time and type of patient contact were content analyzed with the smallest phrase or sentence representing a "unit." These units were then classified using the Omaha Classification System to determine patient problems and APN interventions. Groups were compared concerning total amount of APN time, number of contacts per patient, and mean length of time per APN contact. All studies were conducted in the United States. Groups with greater mean APN time and contacts per patient had greater improvements in patients' outcomes and greater health care cost savings. Of the 150,131 APN interventions, surveillance was the predominant APN function in all five patient groups. Health teaching, guidance, and counseling was the second most frequent category of APN intervention in four of the five groups. In all five groups, treatments and procedures accounted for < 1% of total APN interventions. Distribution of patient problems (N = 150,131) differed across groups reflecting the health care problems common to the group. Dose of APN time and contacts makes a difference in improving patient outcomes and reducing health care costs. Skills needed by APNs in providing transitional care include well-developed skills in assessing, teaching, counseling, communicating, collaborating, knowing health behaviors, negotiating systems, and having condition-specific knowledge about different patient problems.

A neural network aid for the early diagnosis of cardiac ischemia in patients presenting to the emergency department with chest pain

Study objective: Chest pain is the second most common chief complaint presented to the emergency department. Although the causes of chest pain span the clinical spectrum from the trivial to the life threatening, it is often difficult to identify which patients have the most common life-threatening cause, cardiac ischemia. Because of the potential for poor outcome if this diagnosis is missed, physicians have had a low threshold for admitting patients with chest pain to the hospital, the vast majority of whom are found not to have cardiac ischemia. In an earlier study with a large chest pain patient registry, an artificial neural network was shown to be able to identify the subset of patients who present to the ED with chest pain who have sustained acute myocardial infarction. The objective of this study was to use the same registry to determine whether a network could be trained accurately to identify the larger subset of patients who have cardiac ischemia. Methods: Two thousand two hundred four adult patients presenting to the ED with chest pain who received an ECG were used to train and test an artificial neural network to recognize the presence of cardiac ischemia. Only the data available at the time of initial patient contact were used to replicate the conditions of real-time evaluation. Forty variables from patient history, physical examination, ECG, and the first set of chemical cardiac marker determinations were used to train and subsequently test the network. The network was trained and tested by using the jackknife variance technique to allow for the network to be trained on as many of the features of the small subset of ischemic patients as possible. Network accuracy was compared with 2 existing aids to the diagnosis of cardiac ischemia, as well as a derived regression model. Results: The network had a sensitivity of 88.1% (95% confidence interval [CI] 84.8% to 91.4%) and a specificity of 86.2% (95% CI 84.6% to 87.7%) for cardiac ischemia despite the fact that a mean of 5% of all required network input data and 41% of cardiac chemical marker data were missing. The network also performed more accurately than the 3 other tested approaches. Conclusion: These data suggest that an artificial neural network might be able to identify which patients who present to the ED with chest pain have cardiac ischemia with useful sensitivities and specificities. [Ann Emerg Med. 2002;40:575-583.]

2001-2002 SAEM emergency medicine faculty salary and benefits survey.

The Society for Academic Emergency Medicine (SAEM) commissioned an emergency medicine (EM) faculty salary and benefits survey for all 2001 residency review committee (RRC)-EM-accredited programs using the SAEM fifth-generation survey instrument. Responses were collected by SAEM and blinded from the investigators. Data represent compensation paid for the 2001-02 academic year. Seventy-six of 124 (61%) accredited programs responded, yielding usable data on 1,355 full-time faculty representing all four Association of American Medical Colleges (AAMC) regions. Blinded program and individual faculty data were entered into a customized version of Filemaker Pro, a relational database program with a built-in statistical package. Salary data were sorted by criteria such as program region, faculty title, American Board of Emergency Medicine (ABEM) certification, academic rank, years postresidency, program size, and whether data were reported to the AAMC. Demographic data were analyzed with regard to numerous criteria, including department staffing levels, emergency department (ED) volumes, ED length of stay, department income sources, salary incentive components, research funding, and specific type and value of fringe benefits offered. Data were compared with those from previous SAEM studies. Mean salaries were reported as follows: all faculty, $180,913; first-year faculty, $147,746; programs reporting data to the AAMC, $174,354; programs not reporting data to the AAMC, $191,397. Mean salaries as reported by AAMC region: northeast, $178,593; south, $176,314; midwest, $200,095; west, $166,779. Full-time emergency medicine residency program faculty work an average of 1,129 clinical hours per year. Reported salaries for full-time EM residency faculty have risen approximately 8.7% since the last survey. Up to approximately 1,200 clinical hours worked per year, salary varies inversely with clinical hours worked. Total per-faculty patient contact time (overall workload) has grown approximately 13% since the last survey. Patient wait times have increased approximately 27% since the last survey. Significant regional differences in salaries have been present in all five SAEM surveys. Emergency medicine residency faculty continue to work at the upper extremes of patient encounters per physician, patient acuity levels, and department lengths of stay.

Superior student chart notes challenge Medicare documentation policies.

Superior student chart notes challenge Medicare documentation policies.

Hypothetical model of the financial impact of student attachments on rural general practices

Is teaching a medical student always a financial burden on rural general practice? If so, is the current trend towards increasing placement of students in rural practice sustainable? Retrospective studies of short-term attachments to rural general practice have repeatedly shown a financial cost to the practice. Might the results be different for extended attachments? This paper presents the results of a small prospective study of the financial impact of undergraduate medical students undertaking the Parallel Rural Community Curriculum, a 12 month clinical attachment to rural general practice in the Riverland region of South Australia. Students and doctors involved in the program kept separate logs of patient contact time. These data were triangulated with third-party direct observation of consultations and an exit questionnaire on patient satisfaction. In this study, where students had already been actively involved in all aspects of the practice for at least 5 months, it was found that students had a positive effect on general practitioner productivity, without any loss in patient satisfaction. To account for these findings, a hypothetical model has been developed of the financial impact of a student on a rural general practice over time. With the current trend in medical schools to undertake increasing amounts of teaching in rural general practice, it is suggested that it may be more economically sustainable if curricula are adapted to allow extended attachments, likely to be at least 5-6 months, rather than traditional shorter rotations.

Ambulance times of Ankara emergency aid and rescue services' ambulance system.

The aim of this study was to determine various times related to the ambulance activities of Ankara Emergency Aid and Rescue Services (EARS) and if necessary contribute to the improvement of them. A descriptive study was planned to determine various times related to the ambulance activities of Ankara EARS. The data was collected by one of the researchers. The study was conducted between 1 October 1995 and 30 September 1996. The variables of the study were: delay time, response time, time at the scene (scene time), round trip time, transport time and total run time of Ankara EARS ambulance activities. Ankara EARS Emergency Call Registry Forms (5638 forms) were evaluated for the above stated variables. The computer program EPI-INFO 5.0 was used in the study. The median response time of Ankara EARS was found to be 9 minutes. In the research year, the median delay time was 2 minutes. Median arrival to patient contact time of Ankara EARS was 2 minutes. Median time at the scene was 7 minutes. Median round trip time of the system was 44 minutes. The median time to arrive at the scene from the ambulance station was 8 minutes. The median transport time was 10 minutes. The median total run time was 30 minutes. As the median response time was found to be 9 minutes it is concluded that there should be more ambulance vehicles to improve this time of Ankara EARS. Due to financial problems, times were recorded manually by the ambulance crew and dispatchers of Ankara EARS. If digital and electronic recording systems are used, these times might be more precise.

An interview study of the working ward round as an instrument of experiential learning in postgraduate medical education: a preparatory exploration

Recent policy in postgraduate medical education (PGME) in the United Kingdom has favoured a diminution of the experiential dimension of learning through reduced patient contact time. In this changing learning environment, the author describes research into attitudes of trainees to the hospital working round as an instrument of learning in PGME. In an interview study, a description and preliminary analysis of junior doctors’ thoughts was made, with respect to factors enhancing the learning experience of hospital working rounds. The subjects discussed factors making a ‘good teacher’ and were asked what, already with many years experience of rounds, would they do to make such activities a valuable learning experience when they themselves achieve consultant status. There were many qualities of a good teacher, which might have been predicted from learning theory, but it became clear that many of the features of a good learning experience were also dependant on the trainee's opinion of the clinical professionalism of the consultant. Enough common categories were found in this preliminary analysis to be useful in a larger-scale programme, perhaps using structured interview.

Cause, prevalence, and response to occupational musculoskeletal injuries reported by physical therapists and physical therapist assistants.

Physical therapists (PTs) and physical therapist assistants (PTAs) are susceptible to occupational musculoskeletal injuries. The purpose of this study was to examine the reported causes and prevalence of occupational musculoskeletal injuries to PTs and PTAs during a 2-year period. A questionnaire was mailed to 500 PTs and 500 PTAs randomly selected from the American Physical Therapy Association 1996 active membership list. Six hundred sixty-seven questionnaires were returned, giving a response rate of 67%. Based on a literature review and a pilot study, an occupational injury questionnaire was constructed and mailed. Self-reports of injuries were obtained. Thirty-two percent of the PTs and 35% of the PTAs reported sustaining a musculoskeletal injury. The highest prevalence of injury was to the low back (62% of injured PTs and 56% of injured PTAs). The PTs reported the upper back and the wrist and hand as having the second highest prevalence (23%). The PTAs reported the upper back as having the second highest prevalence (28%). The PTs and PTAs reported making changes in their work habits of improved body mechanics, increased use of other personnel, and frequent change of work position. The majority of PTs and PTAs reported they did not limit patient contact time or area of practice after sustaining an injury. Although PTs and PTAs are recognized to be knowledgeable in prevention and treatment of musculoskeletal injuries, they are susceptible to sustaining occupational musculoskeletal injuries because of performing labor-intensive tasks.

Diagnostic problems in three pediatric neurology practice plans

Outpatient information was collected during 8 consecutive months from three different practice plans and analyzed for trends in diagnostic problems. At the time of patient contact, 1,635 patient visits were documented. The data were obtained from government clinics, a capitated contract setting, and a fee-for-service private clinic. Headache, epilepsy, and developmental delay were the most common diagnoses in all three settings. Cerebral palsy had a relatively low incidence. The types of complaints are clearly different depending on the practice setting. The factors responsible for these patterns are discussed.

The prevalence of Helicobacter pylori in practising dental staff and dental students

Recent studies suggest Helicobacter pylori is spread by faecal-oral or oral-oral transmission. Gastroenterologists who are exposed to gastric secretions and saliva have a high prevalence of H. pylori infection. Venous blood was obtained from 92 dentists, 40 dental nurses, 33 fifth year and 30 first year dental students. An ELISA assay was used to detect H. pylori IgG antibodies. Results were compared with an age and sex matched normal population. The prevalence of H. pylori infection in dentists, dental nurses, fifth year dental students and first year dental students were 23 per cent, 18 per cent, 18 per cent and 16 per cent, respectively. There were no significant differences when compared with the normal population controls. The prevalence of H. pylori antibody was not significantly increased with years of practice or patient contact time in dentists and dental nurses. Helicobacter pylori infection is uncommon in dental professionals working in the oral cavity.

Photography of dermatological conditions using polarized light.

The author set up a photographic trial in order to determine the practicality of using photography with parallel- and cross-polarized light alongside routine clinical photography, and the usefulness of the resultant images in comparison with conventional photographs. It was found that the technique added no more than 5 min to patient contact time, and that the attendant cost was minimal. Parallel-polarization has proved relatively valueless, but cross-polarization significantly enhanced the definition of pigmented lesions, and has considerable potential as a technique for documenting specific conditions, and as a teaching aid.

The Mental Status Examination in Neurology

Simplified explanation of exam procedures such as assessment of level of consciousness, language acuity, memory, and attention Pocket card summarizes the main points to remember in assessing mental status in limited patient-contact time DSM-IV diagnostic criteria are covered to ease filling out insurance forms Findings about cognition and testing a patient's mental function Covers the refinement of testing procedures and the psychological test battery to speed up the exam Presents age-related norms, important when assessing the elderly for early dementia Reviews ways to use the exam as a screening procedure, particularly when diagnosing dementia and differentiating between organic and functional disorders

Fee-for-time system. A conceptual framework for an incentive-neutral method of physician payment.

SHOULD physicians be paid for anything but their time? The two prevailing modes of physician reimbursement, fee for service and capitation, do not pay physicians solely for their time; therefore, these modes create financial incentives that may affect physician behavior. 1,2 Salary, the third method of physician payment, is less prevalent in the United States. During the past 50 years, the financial incentives that drive the usual (or prevailing), customary, and reasonable fee-for-service method of physician payment have led to inflated charges with substantial distortions among physician specialties and for various services. 3 The resource-based relative value scale (RBRVS) was created for Medicare to establish an alternative, fair, and equitable fee-for-service physician payment system. 4-6 The RBRVS bases physician reimbursement on five factors, or resource inputs, that describe a service. One of these factors is patient contact time. The other factors are preservice and postservice time, intensity per unit of