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Research and development of out‐patient case mix systems, to plan and monitor resource use in the out‐patient sector, has hitherto not been accorded priority in the NHS. As part of an investigation of their usefulness, a survey of NHS professionals′ requirements for out‐patient case mix was conducted. The results confirmed that there was support for developing out‐patient case mix systems, although different users had different requirements. However, a common theme to emerge was the desirability of constructing holistic systems which cover in‐patient, day‐case and out‐patient care. Additionally, development of care packages was seen as a necessary first step in constructing systems for out‐patient care. Concludes that visit‐based case mix systems are unlikely to fulfil users′ requirements and recommends that case mix contracting projects by Healthcare Resource Groups should be extended to the out‐patient sector, but must recognize that existing systems do not meet users′ requirements.

This paper aims to determine the one‐year incidence of, and risk factors for, perioperative adverse events during in‐patient and out‐patient anesthesia‐assisted procedures.

A quality assurance database was the primary data source. Outcome variables were death and the occurrence of any adverse event. Risk factors were ASA physical status (PS), age, duration and type of anesthesia care, number of operating rooms running, concurrency level and medical staff. Data were stratified by in‐patient or out‐patient, surgical (e.g. thoracotomy) or non‐surgical (e.g. electroconvulsive therapy), and were analyzed using Chi square, Fisher's exact test and generalized estimating equations.

Of 27,970 procedures, 49.8 percent were out‐patient and greater than 80 percent were surgical. For surgical procedures, adverse event rates were higher for in‐patient than out‐patient procedures (2.11 percent vs. 1.45 percent; p<0.001). For non‐surgical procedures, adverse event rates were similar for in‐patients and out‐patients (0.54 percent vs. 0.36 percent). The types of adverse events differed for in‐patient and out‐patient surgical procedures (p<0.001), but not for non‐surgical procedures. ASA PS, age, duration of anesthesia care, anesthesia type and medical staff assigned to the case were each associated with adverse event rates, but the association depended on the type of procedure.

In‐patient and out‐patient surgical procedures differ in the incidence of perioperative adverse events, and in risk factors, suggesting a need to develop separate monitoring strategies.

The paper is the first to assess perioperative adverse events amongst in‐patient and out‐patient procedures.

The validity of an approach based on a quality system specification developed from BS5750 is considered, with reference to patient care activity in an out‐patient clinic at a general hospital. The quality systems specification is presented and the application of this system to the clinic and service departments is demonstrated.

Up‐to‐date patient records are essential for safe and professional practice. They are an intrinsic component for providing adequate care and ensuring appropriate and systematic treatment plans. Furthermore, accurate and contemporaneous notes are essential for achieving professional standards from a medico‐legal perspective. The study's main aim was to investigate current record‐keeping practices by looking at whether out‐patient communication pathways to general practitioners, from letter dictation to insertion in the chart, were being satisfied.

From current out‐patient attendees over six months, 100 charts were chosen randomly, and reviewed. A pro‐forma was used to collect data and this information was also checked against electronic records.

Of the charts reviewed, 15 per cent had no letter. If one considers that one‐month is an acceptable time for letters to be inserted into the chart, then only 11 per cent satisfied this condition. Electronic data were also missing.

It is impossible to discern whether letters to GPs were dictated by the out‐patient doctor for each patient reviewed. Another limitation was that some multidisciplinary hospital teams have different out‐patient note‐keeping procedures, which makes some findings difficult to interpret.

The review drew attention to current record‐keeping discrepancies, highlighting the need for medical record‐keeping procedures and polices to be put in place. Also brought to light was the importance of providing a workforce sufficient to meet the out‐patient team's administrative needs. An extended audit of other medical record‐keeping aspects should be carried out to determine whether problems occur in other areas.

The study highlights the importance of establishing agreed policies and procedures for out‐patient record keeping and the need to have a checking mechanism to identify system weaknesses.

In December 1989, the Government of Kenya implemented cost sharing reforms in a substantial portion of public health facilities. In September 1990 the Government suspended registration fees for out‐patient treatments, but reintroduced them in April 1992 after a lapse of a 20‐month period. Assesses the effects of these policy changes on demand for out‐patient services using a small data set from a rural district in central Kenya. Finds that, although medical services are inelastic with respect to user charges, cost sharing led to a significant reduction in out‐patient attendance: demand for out‐patient care declined by about 40 per cent. Consistent with this finding, suspension of registration fees in 1990 is associated with a 30 per cent increase in attendance. This increase occurred despite the retention of fees for diagnostic services. By March 1991, seven months after the suspension of fees, service demand had recovered remarkably and was only about 20 per cent below its original level. Further, finds that patients are more sensitive to fees for diagnostic services than they are to registration fees.

The objective of this study was to describe the information requirements and beliefs of hospital doctors working in out‐patient departments at the point where a decision to discharge or retain a patient is made. A preliminary assessment of clinical vignettes was followed by discussions using a nominal group technique with doctors working within out‐patient clinics. Nine consultant rheumatologists, seven consultant vascular surgeons and seven senior house officers, on a rotational training scheme in general medicine, took part. Their ranked opinions were the principal outcome measures. In each of the three settings, hospital clinicians affirmed that clinical considerations were the overriding factors involved in the decision to discharge or retain patients. These were mainly expressed as beliefs that the patient should be fully investigated or that the clinical management required skills only available within the speciality out‐patient clinic setting. The senior house officers believed that informal guidelines existed in each of their clinics. Guidelines were usually transmitted by more senior doctors working in the clinic but were, at times, inconsistent so that uncertainty existed for individual discharge decisions. The information requirements and beliefs of senior house officers did not change during the six months between assessments. Consultants working in out‐patient clinics are consistent in their information‐gathering and belief systems. That is to say, consultants in the specialties studied agreed with one another in the discussion groups. They may fail to communicate this fully to their junior staff. Explicit guidelines for junior staff based on diagnostic and disease severity data would be of value in making discharge decisions more consistent.

The purpose of this paper is to determine the dimensions used in judging the hospital services quality; to develop a tool for measuring perceived service quality for hospitals; to test the validity and reliability of the new scale; and finally to use the results of the data collected to suggest improving service quality.

A cross-sectional field study was conducted among 400 hospital out-patients in Thailand. The researchers administered the SERVQUAL instrument in order to assess the applicability of these service quality attributes to the out-patient hospital setting in Thailand. The data collected were used to assess the psychometric properties of the SERVQUAL instrument and to analyze whether and to what extent the SERVQUAL dimensions adequately predicted overall service quality among Thai hospital out-patient respondents. The psychometric properties of the instrument were quite acceptable and the resulting five-factor structure was consistent to and confirms earlier measurement theory. The measurement model as estimated by the use of structural equation modeling further showed that the hypothesized model fit the empirical data quite well.

The results indicate that SERVQUAL's five latent dimensions had a significant influence on overall service quality. Responsiveness had most influence; followed by empathy, tangibles, assurance; and finally reliability.

The results of this study demonstrate that service quality can be assessed in diverse service settings such as hospital out-patient departments. Further, SERVQUAL is robust enough to capture the critical elements used to assess overall service quality. The study was limited in its external validity and prediction was constrained due to the nature of the data collected, i.e. cross-sectional design. This study also chose to focus on one outcome variable, i.e. overall service quality. Other critical variables might be reasonably assessed, e.g. customer satisfaction, loyalty intentions, firm performance.

The present study has several managerial implications for service quality enhancement in the hospitals in Thailand. First, given that responsiveness, was the strongest predictor of service quality, hospital out-patient employees can exercise strong influence over perceived quality by giving sincere and detailed information about service conditions, by being willing to help and by offering fast and efficient service to out-patients.

The World Bank reports that health care and hospital care in particular is a growing portion of the economic pie, now nearly 18 percent of GDP in the USA. Global health care administrators are under pressure to not just control costs but to offer a quality health care experience This study offers insight into how the health care out-patient consumer views service quality and the relative importance of the various service quality dimensions in predicting overall service quality.

Migration appears to be a determinant in health-care utilisation, particularly among the elderly in India. Ageing and migration are essential socio-demographic phenomena in the 21st century for developing and developed countries to establish better public health-care policies. This study aims to focus on the status and determinants of health-care utilisation among elderly migrants who have migrated after attaining the age of 45 and above.

This study used the data from the first wave of the longitudinal ageing study in India (LASI) in 2017–2018. Two outcome variables were used to examine the health-care utilisation, including in-patient and out-patient care. Binary logistic regression was used to explore the predictors of healthcare utilisation in terms of in-patient and out-patient care among the elderly migrant population.

A total of 82.9% of elderly migrants had visited out-patient care when they were sick, whereas 15.3% have used in-patient care. Enabling factors, such as wealth quintile and health insurance, and need factor, such as chronic disease and self-rated health, were more significant factors influencing the health-care utilisation.

This study contributes to our understanding of older migrants’ health-care utilisation. Focussing on this study’s outcome, policymakers and decision makers may consider improving older migrants’ access to health-care by raising their income level, offering local health insurance and health awareness programs.

One of the key objectives in the Patient’s Charter was to reduce the amount of time typically spent waiting for treatment in NHS out‐patient clinics, a documented source of discontent. Presents the results of a quality improvement programme instituted at Leicester General Hospital. Discusses some of the techniques and problems encountered in the measurement exercise. While the results of the monitoring exercise indicated that waiting times were being radically reduced, doubt is expressed as to whether this one simplistic indicator is sufficient to measure the overall quality of out‐patient clinics. There is a danger that measurement systems have concentrated on that which is measurable rather than that which is significant. In particular, the voice of the patient is not incorporated into the league table approach to out‐patient quality. Discusses several approaches to the measurement of overall quality and the problems and dangers inherent in adopting a league table approach to quality measurement.

Overwork and overcrowding in some periods was an important issue for the out‐patient department of a local hospital in Chia‐Yi in Taiwan. The hospital administrators wanted to manage the patient flow effectively. Describes a study which focused on the utilization of doctors and staff in the out‐patient department, the time spent in the hospital by an out‐patient, and the length of the out‐patient queue. Explains how a computer simulation model was developed to study how changes in the appointment system, staffing policies and service units would affect the observed bottleneck. The results show that the waiting time was greatly reduced and the workload of the doctor was also reduced to a reasonable rate in the overwork and overcrowding periods.