Improving the organization of consultation departments in university hospitals

Changes in the demography of doctors require changes in care practices.

The aim of this study was to identify factors associated with doctors' workload in the ophthalmology consultation department of a university hospital, with a view to developing methods to improve the organization of hospital outpatient clinics.

A 10-day cross-sectional survey was carried out in an ophthalmology outpatient clinic (in- and outpatient consultations, including emergencies) specializing in the uveitis care. Demographic and management data for each patient were collected on a structured form. The doctor's workload was assessed, using a scale taking into account the duration of the consultation and the number of diagnostic tests performed, as a function of management complexity.

Of the 861 consultations studied, 39.7% were highly complex. The level of complexity of consultations was correlated with the type of referral (phi = 0.602), consultation duration (phi = 0.545), the number of consultations in the previous year (phi = 0.499), and the number of diagnostic tests performed (phi = 0.445). Consultations were longer and diagnostic tests were more frequently performed if patients had been referred by an ophthalmologist, consulted a faculty doctor or a fellow, or presented with uveitis. Consultations were also more complex for patients with at least four previous consultations in the past year.

Type of referral, status of the attending doctor and number of consultations within the course of 1 year were associated with doctors' workload and could be taken into account to predict the duration of complexity of consultations when scheduling appointments.