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Objective: Delayed medical care may be costly and dangerous. Examining referral pathways may provide insight into ways to reduce delays in care. We sought to compare time between initial referral and first clinic visit and referra...
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Objective: Delayed medical care may be costly and dangerous. Examining referral pathways may provide insight into ways to reduce delays in care. We sought to compare time between initial referral and first clinic visit and referral and surgical intervention for index otolaryngologic procedures between a public safety net hospital (PSNH) and tertiary-care academic center (TAC). Methods: Retrospective cohort study of eligible adult patients undergoing one of several general otolaryngologic procedures at a PSNH (n = 216) and a TAC (n = 161) over a 2-year time period. Results: PSNH patients were younger, less likely to have comorbidities and more likely to be female, Hispanic or Asian, and to lack insurance. Time between referral and first clinic visit was shorter at the PSNH than the TAC (Mean 35.8 +/- 47.7 vs 48.3 +/- 60.3 days; P = .03). Time between referral and surgical intervention did not differ between groups (129 +/- 90 for PSNH vs 141 +/- 130 days for TAC, P = .30). On multivariate analysis, the TAC had more patient-related delays in care than the PSNH (OR: 3.75, P < .001). Time from referral to surgery at a PSNH was associated with age, source of referral, type of surgery, diagnostic workup and comorbidities, and at a TAC was associated with gender and type of surgery and comorbidities. Conclusions: Sociodemographic differences between PSNH and TAC patients, as well as differences in referral pathways between the types of institutions, influence progression of surgical care in otolaryngology. These differences may be targets for interventions to streamline care.
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Though motivational interviewing (MI) has demonstrated efficacy in a range of behaviour change settings, effectiveness will require successful integration into everyday practice. This study examines implementers' views on deliveri...
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Though motivational interviewing (MI) has demonstrated efficacy in a range of behaviour change settings, effectiveness will require successful integration into everyday practice. This study examines implementers' views on delivering MI within an exercise referral scheme and consistency of consultations with MI before and after a 2-day workshop. Method: Semi-structured interviews were conducted with 27 exercise professionals and 10 area coordinators delivering the Welsh National Exercise Referral Scheme (NERS), and the MI trainer. Eleven professionals provided consultation recordings before and 6-months after training, coded for fidelity using the Behaviour Change Counselling Index. Results: The workshop was well received by most, triggering increased recognition of potential motivational roles of consultations. However, some cited difficulties combining MI with structured data gathering activities, whilst a minority rejected MI, seeing current practice as effective, or MI as unnecessary because patients were ready to change. Although limited aggregate improvement in practice was observed, substantial improvements were observed in some individuals. Comments on the need for further practice or training were widespread. Conclusions: Efforts to implement MI should ensure that training and structures to provide monitoring and feedback are in place and that activities incorporated within consultations are compatible with MI delivery.
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Venture capital is a socially embedded business where VCs refer investment opportunities to one another. While we know that these referrals increase the chances of a start-up passing the initial screening process, we investigate t...
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Venture capital is a socially embedded business where VCs refer investment opportunities to one another. While we know that these referrals increase the chances of a start-up passing the initial screening process, we investigate to what extent the intensity of relational embeddedness between referrer and referee relates to the length of the due diligence process of the start-up being referred. Extending information processing theory by social network theory arguments, we argue that referees have access to more and better information during the due diligence as relational embeddedness increases. This will lead to a more in-depth and rigorous evaluation. Moreover, the referee will be subject to social obligations to invest additional resources in the assessment, the more so, the stronger the relational embeddedness. Both factors lead to a prolongation of the due diligence process. Furthermore, we find that the individual investment manager's current performance and experience moderate this relationship.
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Reducing delays between primary care and specialty care visits is critical to improving continuity of ambulatory care delivery. To comply with referral protocols, personnel involved in patients' care pathways process and record pe...
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Reducing delays between primary care and specialty care visits is critical to improving continuity of ambulatory care delivery. To comply with referral protocols, personnel involved in patients' care pathways process and record pertinent information to ensure appropriate care is rendered, and missing necessary information might cause "dropping of the baton" during the patient transition. The objective of this paper is to analyze the information flow along patients' primary care to specialty care referral pathway, and identify system bottlenecks to enhance the workflow design and workforce configuration. A semi-Markov process is introduced to describe information transition and the operations of involved personnel are modeled as capacity-constrained service queues at every stage of referral pathway. Analytical formulas are derived to evaluate the overall referral delay, and a continuous improvement method is developed to identify the most critical factor that impedes the referral process. The proposed systems approach is applied to the clinics of a large academic medical center, and the analysis stresses the importance of building a health information system that supports breaking silos and adapting providers' workflows to the information system to facilitate smart and connected care delivery.
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Both physician and patient play a role in the referral process for cancer genetic counseling. Access to such counseling is not optimal because some eligible patients are not being reached by current referral practice. We aimed to ...
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Both physician and patient play a role in the referral process for cancer genetic counseling. Access to such counseling is not optimal because some eligible patients are not being reached by current referral practice. We aimed to identify factors associated with the initiator of referral. During a 7-month period, we recorded demographic characteristics like gender, personal and family history of cancer, ethnicity and eligibility for genetic testing for 406 consecutive counselees using a specially designed questionnaire. Counselees were seen in a university hospital or a community hospital (n = 7) in the Netherlands. We also recorded educational level of each counselee, clinical setting and who initiated referral. Descriptive statistics were used to describe the counselees’ general characteristics. We analysed the association between counselee characteristics and the initiator of referral by logistic regression. The majority of counselees seemed to have initiated referral themselves but were indeed eligible for genetic testing. In comparison to the general population in the Netherlands, the counselees had a higher level of education, and there were fewer immigrants, although a higher level of education was not found to be a facilitating factor for referral. The clinical setting where a counselee was seen was associated with initiator of referral, although this relationship was not straightforward. There is a complex interaction between clinical setting and initiator of referral, which warrants further research to elucidate the factors involved in this relationship. Patients seen in cancer genetic counseling do not reflect the general population in terms of educational level or ethnicity.
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For veterinary nurses working in a referral setting, communicatior with clients at admission can pose a challenge. The focus of a veterinary surgeon': consultation may focus on the patient's medical presentation, limiting informat...
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For veterinary nurses working in a referral setting, communicatior with clients at admission can pose a challenge. The focus of a veterinary surgeon': consultation may focus on the patient's medical presentation, limiting informatior pertinent to a nursing assessment (e.g. normal mobility, normal toileting habits] The nursing process indicates that nurses must carry out a nursing assessment ir order to create nursing care goals. If the assessment is based on limited information veterinary nursing assessments are also limited. The author developed a nursint assessment document for clients to complete; facilitating more tailored nursing can in a referral hospital setting.
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Background and purpose: There are several cost-benefit evaluations of introducing new technology for administrative purposes in the health care sector. Whereas some of these recognise the importance of adapting the working procedu...
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Background and purpose: There are several cost-benefit evaluations of introducing new technology for administrative purposes in the health care sector. Whereas some of these recognise the importance of adapting the working procedures to the new technology, very few look into the consequences of delays in adaptation to the new technology. In this paper, we focus on the consequences of keeping old working procedures, although new technology is implemented.
Methods: Based on on-site observations we have estimated the economic gains of implementing electronic message exchange in the health care sector depending on which working procedures are applied. Then we continue by using a dynamic cost-benefit analysis (CBA) in order to take into account that conversion to new working procedures takes place over time, and we demonstrate the loss in potential gains due to such a delay. Results: Keeping working procedures fit to old technology when new technology is implemented may imply that only between 40 and 50% of the potential time savings (benefits) are realised. In a dynamic perspective, the keeping of double procedures for 10 years and more will jeopardise the economic gains for surgeries, whereas hospitals still may have an economic gain. The delay in conversion to new working procedures implies that only 50% of the dynamic net present value of the gains is realised. The longer it takes before the old procedures are abandoned the lower is the dynamic net present value of the gains. This is due to the discounting of future gains.
Conclusions: These are all arguments for emphasising and putting resources into training and motivation programs for employees when new technology is being implemented. Limitations of the study: We have only considered quantifiable effects of electronic message exchange in the health care sector, and only for hospitals and surgeries.
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Purpose: Enrolment process influences the likelihood of patients' inclusion in early clinical trials (ECT) through social, medical and organisational factors.
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BACKGROUND: The emergence of bacterial antimicrobial resistance associated with acquired infections has made the choice of empirical therapy more difficult and expensive, hence the need for continuous research to determine their s...
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BACKGROUND: The emergence of bacterial antimicrobial resistance associated with acquired infections has made the choice of empirical therapy more difficult and expensive, hence the need for continuous research to determine their sensitivity patterns. OBJECTIVES: To identify the common aerobic pathogenic bacteria in post-operative wounds at Moi Teaching and Referral Hospital (MTRH) and determine their sensitivity patterns to routine antibiotics used. DESIGN: Cross-sectional study. SETTING: Moi Teaching and Referral Hospital (MTRH) Surgical, Obstetrics and Gynaecology wards. PATIENTS: Sixty three patients chosen by convenient sampling between May and June 2001 were included in the study. A total of eighty four isolates were obtained from these patients. MATERIALS AND METHODS: Isolation of pathogens and their antibiotic sensitivity determination was conducted in the Department of Medical Microbiology Laboratory, Faculty of Health Sciences, Moi University. The bacteria were cultured on blood agar, MacConkey and Nutrient agar followed by identification using biochemical tests (catalase urease, coagulase, triple sugar iron). Disc diffusion method on Muller-Hinton agar was used for sensitivity testing. RESULTS: Staphylococcus aureus species were the most common pathogenic bacteria isolated from the post-operative wounds. Other organisms included Proteus, Pseudomonas and Escherichia coli. There was a multi-drug resistance pattern observed, with minocyline being the most effective drug against S. aureus. CONCLUSION: There is need for review of policies on prescription practice on the use of existing therapeutics choice to limit the spread of resistance. This will ensure reduced patient stay and cost incurred.
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