BACKGROUND

Waiting time of patients from a consult with a primary care physician to a specialist is poorly understood. It is one indicator of health service delivery and patient satisfaction. Patients consider waiting for a specialist consult for more than three months too long and unacceptable.

OBJECTIVES

To describe the sociodemographic and clinical factors associated with length of referral waiting time.

METHOD

Cross-sectional retrospective chart review of patient records in a tertiary government hospital from 2015 to 2019.

RESULTS

A total of 366 charts were reviewed. Many of the patients referred to other specialty clinics were middle-aged adults and females. Median wait times for medical and surgical specialties were 11 (IQR: 0-29) and 18 (IQR: 6-35) days, respectively (p=0.003). Nutrition, rehabilitative medicine, and family health unit received the most number of referrals among non-surgical fields. Ophthalmology, otorhinolaryngology, and general surgery received the highest number of referrals among the surgical fields. Referral waiting times were longest for cardiology (median: 125, IQR: 91-275 days) and shortest for nutrition (median: 0, IQR: 0-6 days).

CONCLUSION

Waiting times from a primary care clinic to a specialty clinic at a tertiary government hospital vary based on urgency, specialty clinic, purpose of referral, presence of comorbidities, and chronicity of condition. Clinical factors found to be significantly associated with referral waiting time include urgency, type of clinic, and purpose of referral.

Referral ; Referral And Consultation ; Specialization ; Specialist

BACKGROUND

Length of stay is one of the metrics of crowding in the emergency department. Identification of the factors associated with prolonged length of stay is vital for staffing and policy making to prevent overcrowding at the ambulatory care unit.

OBJECTIVE

This study aimed to determine the association of sociodemographic, clinical, and temporal factors with length of stay among patients seen at the ambulatory care unit of a tertiary government training hospital.

METHODS

A retrospective case-control study was conducted between January to December 2019 at the ambulatory care unit of a tertiary government hospital. Charts of patients who stayed for more than six (6) hours were classified as cases, while those who stayed for more than two (2) hours up to six (6) hours were classified as controls. Charts were reviewed to obtain the clinicodemographic profile of patients who satisfied the inclusion criteria.

RESULTS

The case group consisted of 86 patients, while the control group consisted of 172 patients. Eight factors had an effect on the probability of prolonged length of stay at the ambulatory care unit: age 40-59 years old (OR = 2.29, 95% CI: 1.16-4.49), ESI 3 at triage level (OR = 3.35, 95% CI: 1.50-8.38), psychiatric complaint (OR = 6.97, 95% CI: 2.53-19.21), medications given and diagnostics done (OR = 2.16, 95% CI: 1.16-3.99), medications given/diagnostics/ referral to other services done (OR = 7.67, 95% CI: 2.70-21.80), psychiatric/substance-related case (OR = 6.97, 95% CI: 2.63-18.49), transferred to other services (OR = 3.25, 95% CI: 1.33-7.94), and endorsed to next shift (OR = 6.94, 95% CI = 3.90-12.35).

CONCLUSION

The factors associated with prolonged length of stay were middle-aged adults, conditions with severe presentation, psychiatric/substance-use-related cases, need for more diagnostic test and treatment intervention, and decision to transfer care to other services.

Ambulatory Care ; Urgent Care

Background: Dyspnea also referred to as shortness of breath or breathlessness is defined as “a subjective experience of breathing discomfort that consists of qualitatively distinct sensations that vary in intensity.” Dyspnea is a symptom of the disease, rather than a disease itself. Its etiology can be designated as arising from four primary categories: respiratory, cardiac, neuromuscular, psychogenic, systemic illness, or a combination of these. Objective: The general objective in developing this guideline is to improve the quality and outcomes of care to adult patients with dyspnea or shortness of breath in primary care and outpatient setting. Methods The ADAPTE process was utilized in the development of the initial guideline recommendations where the following steps were followed: 1) definition of clinical questions, 2) searching, screening and appraisal of guidelines, 3) decision and selection of evidence and 4) iterative drafting of guideline recommendation was done. The retrieved guidelines were systematically evaluated for their quality and validity using the Appraisal of Guidelines for Research & Evaluation (AGREE) II Instrument, which is a tool developed to assess the methodological quality of practice guidelines. If the adopted guideline did not have recommendations for our clinical question, we developed the recommendations de novo using the GRADE approach. We prioritized retrieving systematic reviews and meta-analysis articles that are relevant to our clinical questions. In the development of recommendations, the guideline development team prioritized the interventions that address the following outcomes i.e., decrease in severity of dyspnea, resolution of dyspnea, improved quality of life and decrease mortality. Data from the articles were extracted and the evidence was then summarized and appraised based on the type of study. The recommendations were then developed by the team as the initial draft that was subjected to external review and consensus panel discussion for finalization.
Outpatients ; Dyspnea ; Primary Health Care

Background. Telemedicine provides access to health care services during pandemics. It can be utilized to screen asymptomatic persons, follow up close contacts of confirmed cases, monitor individuals with symptoms, conduct specialty consultations, and offer health services to patients during pandemics. Objective. To describe the telemedicine processes, good practices, and areas for improvement in the University of the Philippines Health Service (UPHS) during the COVID-19 pandemic. Methods. This was a cross-sectional study to document telemedicine processes in UPHS. All teleconsultations of employees and students of Philippine General Hospital (PGH) and UP Manila (UPM) during the two-week study period in October 2020 were included. Quantitative data was collected from different modes of patient entry into the UPHS telemedicine services: email, Online Consultation Request and Appointment (OCRA) System, and phone hotlines. Qualitative information was gathered as narrative descriptions of observations in the clinic’s service delivery areas. A focus group discussion was also conducted to illustrate the different steps of the pathway used for telemedicine. Results. The telemedicine services of UPHS consisted of virtual triage, COVID-19/non-COVID-19 consultation, and telemonitoring. The UPHS virtual triage received patient concerns through OCRA or the hotline numbers. On the other hand, the COVID-19 teleconsultation service provided care to employees and students who contacted the clinic regarding symptoms or exposure via email. The non-COVID-19 service had teleconsultation for patients with other medical concerns. Coordination among staff and presence of a consultant were identified as good practices, while the areas for improvement include the lack of written protocols in issuing fit-to-work clearance for difficult cases and the optional use of OCRA for UPHS consult. Conclusion. Telemedicine services at the UPHS included tele-triaging, teleconsultations, and telemonitoring with use of phone calls, short messaging service (SMS), emails, and OCRA. Timely coordination, on-site duty consultants, and use of technology were identified as good practices. Lack of protocols and inconsistent OCRA use are areas for improvement.
Pandemics ; Telemedicine ; Ambulatory Care Facilities