Authors
1 Department of Health Services Management, School of Management and Medical Information Sciences, Shiraz University of Medical Sciences, Shiraz
2 Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
Abstract
Background: The expansion of outpatient services and the desire to provide more outpatient
care than inpatient care create some problems such as the overcrowding in the outpatient
clinics. Given the importance of overcrowding in the outpatient clinics, this qualitative study
aimed to determine the factors influencing the overcrowding in the specialty and subspecialty
clinic of a teaching hospital. Materials and Methods: This was a qualitative study conducted in
the specialty and subspecialty clinic of a hospital using content analysis method in the period
of January to March 2014. The study population was all managers and heads of the outpatient
wards. The studied sample consisted of 22 managers of the clinic wards who were selected
using the purposive sampling method. The required data was collected using semi‑structured
interviews. The collected data was analyzed using conventional content analysis and the
MAXQDA 10.0 software. Results: Three themes were identified as the main factors affecting
the overcrowding including the internal positive factors, internal negative factors, and external
factors. Conclusions: Despite the efforts made to eliminate overcrowding, and reduce waiting
times and increase access to the services for patients, the problem of overcrowding still has
remained unresolved. In addition, the use of some strategies such as clarifying the working
processes of the clinic for staff and patients and the relationships between the clinic and
other wards especially emergency department, as well as using a simple triage system on the
patients’ arrival at the clinic are recommended.
Keywords
of literature. Prod Oper Manag 2003;12:519‑49.
2. Parks JK, Engblom P, Hamrock E, Satjapot S, Levin S. Designed
to fail: How computer simulation can detect fundamental flaws in
clinic flow. J Healthc Manag 2011;56:135‑44.
3. Clements A, Halton K, Graves N, Pettitt A, Morton A, Looke D, et al.
Overcrowding and understaffing in modern health‑care systems:
Key determinants in meticillin‑resistant Staphylococcus aureus
transmission. Lancet Infect Dis 2008;8:427‑34.
4. Milbrett P, Halm M. Characteristics and predictors of frequent
utilization of emergency services. J Emerg Nurs 2009;35:191‑8.
5. Virtanen M, Pentti J, Vahtera J, Ferrie JE, Stansfeld SA, Helenius H,
et al. Overcrowding in hospital wards as a predictor of antidepressant
treatment among hospital staff. Am J Psychiatry 2008;165:1482‑6.
6. Testa S, Paoletti O, Zimmermann A, Bassi L, Cancellieri E.
Telemedicine for managing patients on oral anticoagulant therapy.
Telemed Tech Appl 2011;15:331‑46. 7. Denison A, Pierce JR Jr. Systems analysis of a clinical error. J Public
Health Manag Pract 2003;9:43‑6.
8. Santibáñez P, Chow VS, French J, Puterman ML, Tyldesley S.
Reducing patient wait times and improving resource utilization at
British Columbia Cancer Agency’s ambulatory care unit through
simulation. Health Care Manag Sci 2009;12:392‑407.
9. Greenhalgh T, Collard A, Begum N. Sharing stories: Complex
intervention for diabetes education in minority ethnic groups who
do not speak English. BMJ 2005;330:628.
10. Al‑Otaibi N, Al‑Azemi F, Khalfan M, Makboul G, El‑Shazly M.
Awarness and implementation of hypertention of guidelines in
primary health care in Kuwait. Bull Alex Fac Med 2008;44:735‑42.
11. Ghasemi G, Yavari P, Valiollah Pooramiry S, Mehrabi Khoushki A.
The relationship of patient satisfaction and the academic clinic
physicians’ awareness about gender concordance. J Isfahan Med
Sch 2013;31:1529‑39.
12. Asplin BR, Magid DJ, Rhodes KV, Solberg LI, Lurie N, Camargo CA Jr.
A conceptual model of emergency department crowding. Ann
Emerg Med 2003;42:173‑80.
13. Goldman RD, Cheng A, Jarvis A, Keogh K, Lu GP, Wang JS, et al.
An international fellowship training program in pediatric emergency
medicine: Establishing a new subspecialty in the Land of the Dragon.
Pediatr Emerg Care 2011;27:1208‑12.
14. Qu X, Rardin RL, Williams JA, Willis DR. Matching daily healthcare
provider capacity to demand in advanced access scheduling
systems. Eur J Oper Res 2007;183:812‑26.
15. Ranjbar M, Bahrami M, Sadeghi J, Moradi M, Masoomi R, Baghiyani N,
et al. Estimate the average waiting time to receive service in the
outpatient department: A case study on Shahid Rahnemoon and
Afshar Clinics in Yazd, Iran. Toloo‑e‑behdasht (Res) 2014;13:30‑9.
16. Khiavi FF, Maleki MR, Momtaz NS, Jafarian K. The effect of extended
work shift on performance of Farabi Eye Hospital in Iran. Payesh
2012;11:181‑7.
17. Moazam E, Gholami F, Tavakol N, Far RZ. Inpatient health care
demand and geographic elasticity in Isfahan province using
geographic information systems. Health Inf Manage 2014;10:921‑30.
18. Bahadori M, Raadabadi M, Salimi M, Ravangard R. Discharge against
medical advice: A case study in a public teaching hospital in Tehran,
Iran in 2012. Glob J Health Sci 2013;5:179‑85.
19. Sandelowski M. Whatever happened to qualitative description? Res
Nurs Health 2000;23:334‑40.
20. Su S, Shih CL. Managing a mixed‑registration‑type appointment
system in outpatient clinics. Int J Med Inform 2003;70:31‑40.
21. Mehtar S. Lowbury Lecture 2007: Infection prevention and control
strategies for tuberculosis in developing countries – Lessons learnt
from Africa. J Hosp Infect 2008;69:321‑7.
22. Thompson JA, Lee V. The effect of health insurance disparities on
the health care system. AORN J 2007;86:745‑56.
23. Dodd K, Newton J. Outpatient services for children. Arch Dis Child
2001;84:283‑5.
24. Openshaw MR, Bomela HN, Pretlove S. An evaluation of the timing
and use of healthcare during pregnancy in Birmingham, UK and
Pretoria, South Africa. ISRN Obstet Gynecol 2011;2011:364243.
25. Schwab F, Meyer E, Geffers C, Gastmeier P. Understaffing,
overcrowding, inappropriate nurse: Ventilated patient ratio and
nosocomial infections: Which parameter is the best reflection of
deficits? J Hosp Infect 2012;80:133‑9.
26. Taboada M, Cabrera E, Epelde F, Iglesias ML, Luque E. Using
an agent‑based simulation for predicting the effects of patients
derivation policies in emergency departments. Procedia Comput
Sci 2013;18:641‑50.
27. Murphy SO, Barth BE, Carlton EF, Gleason M, Cannon CM. Does
an ED flow coordinator improve patient throughput? J Emerg Nurs
2014;40:605‑12.
28. Xu M, Wong TC, Wong SY, Chin KS, Tsui KL, Hsia RY. Delays
in service for non‑emergent patients due to arrival of emergent
patients in the emergency department: A case study in Hong Kong.
J Emerg Med 2013;45:271‑80.
29. Derlet RW, Richards JR. Overcrowding in the nation’s emergency
departments: Complex causes and disturbing effects. Ann Emerg
Med 2000;35:63‑8.
30. Hwang JI, Chang H. Understanding non‑emergency patients
admitted to hospitals through the emergency department for
efficient ED functions. J Emerg Nurs 2010;36:196‑202.
31. McGee LA, Kaplan L. Factors influencing the decision to use
nurse practitioners in the emergency department. J Emerg Nurs
2007;33:441‑6.
32. Liu J, Griesman J, Nisenbaum R, Bell CM. Quality of care of
hospitalized internal medicine patients bedspaced to non‑internal
medicine inpatient units. PLoS One 2014;9:e106763.
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