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ORIGINAL ARTICLE  
Year : 2011  |  Volume : 1  |  Issue : 1  |  Page : 28-32
An audit of patients attending outpatient services of Department of Oral and Maxillofacial Surgery at Christian Dental College, Ludhiana, Punjab, India


Department of Oral and Maxillofacial Surgery, Christian Dental College, Ludhiana, Punjab, India

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Date of Web Publication6-Mar-2012
 

   Abstract 

Context: An audit of the patients attending outpatient services of Oral and Maxillofacial Surgery Department was carried out.
Aims: The aim was to study the present process and functioning of the OPD and to formulate suggestions and methods to improve the OPD services.
Settings and Design: A stratified random sampling procedure was used in this study design with a sample size of 100 patients.
Materials and Methods: The study subjects were patients attending the OPD of Oral and Maxillofacial Surgery and were randomly selected for the study and were given a questionnaire to fill. The patients who were not able to understand the language were verbally communicated and made to understand the questionnaire and then duly filled it. Data collectors were the doctors of the Department of Oral and Maxillofacial Surgery.
Results: The results are depicted by text, tables, and figures.
Conclusions: The effect of communication and interpersonal behavior between patients and providers has been shown to affect patient satisfaction, perceptions of care, and even health outcomes in medicine and dentistry. Our study provides evidence for the broad scope of verbal interactions that occur during the dental visit and that these behaviors can be reliably recognized and quantified.

Keywords: Audit, outpatient department services, oral and maxillofacial surgery

How to cite this article:
Bither S, Gandhi S. An audit of patients attending outpatient services of Department of Oral and Maxillofacial Surgery at Christian Dental College, Ludhiana, Punjab, India. J Educ Ethics Dent 2011;1:28-32

How to cite this URL:
Bither S, Gandhi S. An audit of patients attending outpatient services of Department of Oral and Maxillofacial Surgery at Christian Dental College, Ludhiana, Punjab, India. J Educ Ethics Dent [serial online] 2011 [cited 2019 Nov 22];1:28-32. Available from: http://www.jeed.in/text.asp?2011/1/1/28/93407



   Introduction Top


The success of any healthcare setup depends upon the number of patients coming to Outpatient Department (OPD) each day, the efficiency of the health team, the availability of services, and the quality of the treatment offered. The level of healthcare among the Indian population has risen markedly in every aspect, whether in respect of life expectancy, infant mortality rate, healthcare facilities, and more. This can be attributed to the growth of the nation, availability of resources, and technological advancements in field of medicine and dentistry.

While dentistry has a rich literature on patient anxiety, fear, and phobias, much less is known about the routine interactions during the dental visit, which by virtue of their pervasiveness could exert similar effects on oral health outcomes. Direct observation of a large number of patient visits offers the opportunity to collect this information, providing a fuller description of patient visits and complementing the quantitative data on frequency and timing of observed behaviors. The link between procedure-based interactions and verbal interactions is not well characterized and such knowledge will lay the foundation for oral health research on patient and provider behavior change, effects of communication on patient self-care and adherence, and interventions to improve communication and patient-centered care. [1]

The study aims at a comprehensive study of patient satisfaction, efficiency of treatment given, and analysis of the facilities present by means of a preformed questionnaire.

Patients needed to wait for hours before they could be seen by doctors in pubic hospitals have been a symbol of bad service in India. The situation would be especially worse for the sick elderly.

Objectives

The objectives were:

  1. To improve the patient turnout to the OPD of the Department of Oral and Maxillofacial Surgery by gathering information about the referral source of patients so that the turnover of the patients can be improved and services be made better for the patients;
  2. To study the present process and functioning of the OPD;
  3. To identify the areas those require improvement in planning and organizing the same;
  4. To determine the quality of care provided;
  5. To identify problems and highlight areas where expectations and fulfillment do not meet.



   Materials and Methods Top


The proposed study was conducted in the OPD of the Department of Oral and Maxillofacial Surgery of Christian Dental College, Ludhiana. The study population which will be a representative of all age groups includes the patients attending the OPD. The patients were given a preformed questionnaire to be filled either by the patient or the doctor attending the patient.

A simple random sampling procedure was used in this study design with a sample size of 100 patients. Four patients were enrolled into the study in a day and every fifth patient entering the Department was selected (5, 10, 15, and 20). Care was taken to ensure that there was no repetition of the subjects.

The patients who were not able to understand the language were verbally communicated and made to understand the questionnaire and then duly filled after the informed written consent.

Waiting time was the difference between the time a patient handed over the case record file to the OPD and the time the patient was seen.

Data collectors were the doctors of the Department of Oral and Maxillofacial Surgery.

Sample questionnaire

Please tick the appropriate option and fill in the required fields where necessary




   Results Top


There were almost an equal number of males and females [Figure 1]. The maximum number of patients were into some or the other business sector; this correlated very well with the number of industries in Ludhiana followed by agriculturist and service class patients [Table 1] and [Figure 2]. In the education sector uneducated and graduate patients were nearly same in number as depicted in [Table 2]. A total of 63% of the patients were those coming first time to the Hospital. Professionals made the least of the patient group and business community being the most of it. Most of the patients came to the Department by themselves (72%) barring a few who were referred either by private practitioner or other hospitals [Table 3].
Table 1: Patient distribution according to occupation

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Table 2: Level of education

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Table 3: Type of referral

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Figure 1: Distribution of sexes

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Figure 2: Patient distribution according to occupation

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Patient satisfaction

A total of 60% of the patients complained about the lengthy registration time period while a few (2%) did not want to waste time standing in the queue and some were ignorant of the registration process (3%) as depicted in [Figure 3].
Figure 3: Registration process

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Lack of adequate drinking water facilities and toilets were the major issues with the patients while clean environment and surroundings were appreciated by most of the patients. Mixed feelings could be elicited in the seating arrangement in the waiting area - adequate seating but not so comfortable [Table 4].
Table 4: Patient feedback

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Efficiency and quality of treatment

The treatment was executed on the same day for majority of the patients (74%). The patients were attended promptly and if there was a delay they were politely apprised of the delay. A total of 89% of the patients were told about the delay if there was any.

Patients were happy with the treatment and doctor part and well appreciated the clinicians knowledge and approach toward the treatment but wanted the doctor to be more patient in listening to their problems and increase in the consultation time [Table 5].
Table 5: Patients remarks

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Following were the changes the patients wanted in the Department of Oral and Maxillofacial Surgery, Christian Dental College, Ludhiana:

Registration process - 38%

Waiting time - 27%

Doctor's behavior - 11%

Knowledge of doctors - 7%

Facilities in waiting room - 25%


   Discussion Top


Practice-based research networks (PBRNs) were introduced for dental practices in the United States in 1998. This research tool had been utilized extensively to investigate medical practice. [1]

Each source of information provides a unique view of the practice with its own particular bias. One study has used direct observation to look at the frequency (but not time) of services in a public health practice in Sweden, [2] but direct observation has not yet been utilized to examine private dental practice. We designed this multimethod study of dental practices, emphasizing direct observation, to simultaneously illuminate several aspects of dental practice and quantify both procedures and the behavioral content of dental visits.

Patients often spend long waiting times in order to see their dentists, and as per the old saying "time wasted is money wasted," hence bad for economy. A reduction in waiting time thus could improve efficiency and quality of care provided. A study by Mok et al. in Hong Kong stressed on cutting short the waiting time in the specialist clinic both for the hospital functioning and comfort and for the well-being of the frail elderly patients. [3] A study by Jennings showed that the average waiting time for patients may be reduced by giving the doctor responsibility for arranging his own appointments. [4] The other way of reducing the waiting time is identifying the regular cases and emergency ones and forming a triage system that can be managed by the nursing staff. This effectiveness of triage in managing the patients has been very effective as shown by studies by Fenton, [5] Banerjee, [6] and Jones. [7] As the recalled patients require comparatively less time than the new patients, they can be given a particular time slot so that the new OPD patients and old patients do not turn up together leading to rush in the OPD.

The effect of communication and interpersonal behaviors between patients and providers has been shown to affect patient satisfaction, perceptions of care, and even health outcomes in medicine and dentistry. Our study is based upon the verbal interactions that occur during the dental visit and that these behaviors can be reliably recognized and quantified.

Most of the patients were treated the same day and a specialist opinion was given if the treatment could not be executed on the same day which is important if we want the self-referrals to continue and increase in OPD.

The patients were overall satisfied with the quality of the treatment provided but had some reservations regarding the facilities provided in the waiting area, the registration process, and waiting time. They had given the following suggestions:

  1. A welcoming approach to the OPD building, clearly sign posted.
  2. A comfortable ambience inside the OPD with separate waiting spaces for different category of patients provided with newspaper/magazine stands, drinking water facilities, and sanitary blocks.
  3. Recreational facilities in the form of soothing music and wall mounted TV sets.
  4. Digital display system for the patients.


For better patient satisfaction the following can be implemented:

  1. Clear and visible sign boards for patient guidance.
  2. Provision for a well-ventilated waiting area with comfortable chairs and educational materials.


For an efficient system of working and maintaining the standard of care:

  1. Segregation of the follow-up patients and new patients. The days of patient follow-up and timing can be fixed so that the new patients do not end up waiting.
  2. Separate OPD space and manpower for new and follow-up patients. The same thing can be done for patients requiring a specialist opinion.
  3. Separate registration counters for new and old patients.
  4. An online appointment system and file number just like the prior booking system.


To conclude, the study gives the insight of the patients about the treatment executed and the associated parameters. After all it is the patient for whom we study, learn, gain experience, and try to give our best for their benefit, so why not just ask the patient itself what they like, dislike, need to change or what they expect out of us? This will help us to evaluate ourselves, the services we render, and improve our functioning and policies for the betterment of patients and humanity.

 
   References Top

1.Wotman S, Demko CA, Victoroff K, Sudano JJ, Lalumandier JA. A multimethod investigation including direct observation of 3751 patient visits to 120 dental offices. Clin Cosmet Invest Dent 2010:2;27-39.  Back to cited text no. 1
    
2.Swedberg Y, Malmqvist J, Johnsson T. A method for dental care activities time study using observer monitored counting of frequencies. Swed Dent J 1993;17:155-63.  Back to cited text no. 2
[PUBMED]    
3.Mok FC, Au AS. An audit of the patients waiting time in a geriatric specialty clinic. J Hong Kong Geriatr Soc 1993;4:27-9.  Back to cited text no. 3
    
4.Jennings M. Audit of a new appointment system in a hospital outpatient clinic. BMJ 1991;302:148-9.  Back to cited text no. 4
[PUBMED]  [FULLTEXT]  
5.Fenton S, Jackson E, Fenton M. An audit of the ophthalmic division of the accident and emergency department of the Royal Victoria Eye and Ear Hospital, Dublin. Ir Med J 2001;94:265-6.  Back to cited text no. 5
    
6.Banerjee S, Beatty S, Tyagi A, Kirkby GR. The role of ophthalmic triage and the nurse practitioner in an eye-dedicated casualty department. Eye (Lond) 1998;12:880-2.  Back to cited text no. 6
[PUBMED]  [FULLTEXT]  
7.Jones NP, Hayward JM, Khaw PT, Claoue CM, Elkington AR. Function of an ophthalmic accident and emergency department: Results of a six month survey. Br Med J (Clin Res Ed) 1986;18:188-90.  Back to cited text no. 7
    

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Correspondence Address:
Saurab Bither
Department of Oral and Maxillofacial Surgery, Christian Dental College, Ludhiana - 141 008, Punjab
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0974-7761.93407

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    Figures

  [Figure 1], [Figure 2], [Figure 3]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

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