Enhancing consultation time for primary paediatric care in the outpatient department.

Abstract

Objective: To improve the duration and quality of consultation times during paediatric ambulatory care.

Methods and analysis: This, before and after study, compares consultation time and core activities. All the subjects attended the paediatric outpatient department (P-OPD) between 1 July 2013 and 31 October 2013.Initially, consultation time was recorded directly by using observer timing with a stopwatch on 10-12 patients on 3 consecutive days and estimated indirectly after the study. All subjects underwent some or all of the following assessments and interventions (core activities): danger sign detection, illness treatment and referral, growth assessment followed by appropriate dietetic advice, immunisation and parent counselling. We implemented an intervention structure that divided work among staff members and then compared core activities.

Results: During the study period, 2204 patients attended the P-OPD over 108 days. Before the study, the average consultation time was less than 5 min (range 3.5-5 min), and the core activities included the treatment and referrals of illnesses and immunisation only. No treatment guidelines existed, and weight record was primarily for calculating the dose of the drug to be prescribed. The protocol did not include growth assessment and maintenance of detailed clinical records.After implementing the core activities through effective utilisation of existing resources, on an average, 20 patients received consultations per day, and the consultation time was approximately 12 min per patient.

Conclusion: The P-OPD consultation time increased from 3.5-5 min to approximately 12 min per patient. Using the structured interventions, the range of assessments and interventions, during these consultations, increased without having to hire more staff.