Study On The Physicians' Outpatient Workload Of Tertiary Hospitals In A City In Guangdong Province

[Purpose] Based on the measuring of the current situation of the physician outpatient workload from tertiary hospital in in a prefecture-level city in Guangdong Province,combinng with the characteristics of the different clinical departments,our study formulate scientific and reasonable workload standards for relevant departments to establish the standards of outpatient visits for the Public Health Administrative Department,and provide basis for the development of hierarchical medical system and performance appraisal of medical staff.[Methods] 1.The literature survey method was used to summarize the workload standards of the physician in China.2.The delphi method is adopted to clarify the scope of diagnosis and treatment of cardiology,orthopedics,gynecology and pediatrics,then the outpatient diagnosis information in the database is combined according to the principle of similar clinical classification,difficulty in diagnosis and treatment,and time spent by the physician,and the frameworks of each clinical departments are established.And through the consultation results and Program Evaluation and Review Technique(PERT)method to calculate the appropriate diagnosis and treatment time of each disease,each clinical departments our study have consulted the experts three rounds and above.3.Method of statistics:Establish calculation models to measure the workload of the physician's outpatient service and the current workload per hour,the Wilcoxon signedrank test of two pairedsamples were used to analyze the influencing factors of the physician's outpatient workload;Establish other calculation models,and the appropriate workload value of the outpatient physician was predicted.according to the characteristics of each specialty(the disease frameworks and thediseases' appropriate diagnosis and treatment time),and sensitivity analysis was carried out.[Results] 1.The null model result in the two-level linear regression of the physician's outpatient work throughout the day found that the data had nested structural features and clustered at the hospital and department level;after adding the level 1 variable,the results showed that the physician's title had impacts on the outpatient workload throughout the day.2.Hourly outpatient workload: Applying Wilcoxon signedrank test,the hourly workloads between morning and afternoon are different.The morning and afternoon hourly workloads respectively used the empty model in the two-level linear regression,and the result showed that the data has nested structural features and clustered at the hospital and department level;After adding the level 1 variable,the results showed that the physician's title had an impact on the hourly workload both in the morning and afternoon.3.Appropriate workload:Established the disease frameworks of the of the four clinical departments and calculated the appropriate diagnosis and treatment time of each disease,then predicted appropriate workload value of the outpatient physician.The standard interval of hourly workload of the chief physician,deputy chief physician and attending physician of each departments are: cardiology 6-10,6-11,6-12 visit/hour,orthopedics 2-4,3-5,3-5 visit/hour,gynecology 4-7,4-7,4-7 visit /hour,pediatric 7-12,7-12,7-12 visit /hour.In the sensitivity analysis,the types of diseases that have the greatest impact on the appropriate workload for each disease type of the disease,cardiology: primary hypertension,coronary heart disease,chest pain,chest discomfort,chest discomfort,hyperlipidemia,etc.,orthopedics: Neck and shoulder pain,soft tissue strain,spinal osteoarthrosis,osteoarthritis,etc.,gynecology: vaginitis / gynecological examination,AUB(abnormal uterine bleeding),induced abortion,pediatrics: upper respiratory tract disease,acute bronchitis,pneumonia,etc.[Conclusions] It is more scientific and reasonable to choose “hourly workload per hour of each physician” as a measure of physician's outpatient workload than “workload per day of each physician”.The title of the physician in the tertiary hospitals will affect the workload,so it is necessary to distinguish the physician's title when formulating the standards of outpatient visits of each physician;Physicians have different workloads in the morning and afternoon,and the hourly workload in the morning is greater than the afternoon.The physician's title will affect the size of the physician 's outpatient workload,and due to the small difference in reality,the appropriate workload value established by the job title is not much different.It is of practical significance to formulate establish the standards of outpatient visits of each physician in tertiary hospitals,which is conducive to the promotion of hierarchical medical system,and also requires the implementation of relevant supporting measures.The standards of outpatient visits of each physician in the tertiary hospitals should meet the characteristics of the each clinical department(the disease frameworks and its the appropriate diagnosis and treatment time).The Public Health Administrative Department should determine the upper limit of the workload of each clinical department,and the hospital and the hospital sets the range of the standard of the physician 's workload according to the realities,and then the physician determines the standard of half-day workload based on his past experience.According to the positioning of the tertiary hospitals in t hierarchical medical system,the “negative list of disease” of the tertiary hospitals shall be formulated.In the future,The standards of outpatient visits of each physician should be removed the diseases from the negative list and recalculated.