COLUMBIA LIBRARIES OFFSITE HEALTH SCIENCES STANDARD HX641 22581 RC309.N48AS7 A standard tuberculo RECAP Association of Tuberculosis Clinics of the City of New York, A Standard Tuberculosis Clinic MIMHI T ?C3&j.M4# As7 Columbia (Bntomrttp intljeCttpiOrttigork COLLEGE OF PHYSICIANS AND SURGEONS LIBRARY Digitized by the Internet Archive in 2010 with funding from Open Knowledge Commons http://www.archive.org/details/standardtuberculOOasso 7 ff CplWe* of Pby A Standard Tuberculosis Clinic Issued by The Association of Tuberculosis Clinics of the City of New York 105 East 22nd Street .19 Hi (U1 A Standard Tuberculosis Clinic IN order to co-ordinate and standardize the work of the various tuberculosis clinics in New York, in January, 1908, these clinics at that time nine in number, were organized to form an Association of Tuberculosis Clinics. To-day the Association includes twenty-two such clinics in its membership, six under the immediate control of the Department of Health, three maintained by city hospitals and thirteen connected with private institutions. A certain area of the city is allotted to each clinic which assumes the responsibility' for the treatment and home supervis- ion of the cases living within its particular district. All cases applying for treatment to the clinics outside of their district are referred back to the clinic of the district of residence. The Association confines its activities to the Boroughs of Manhattan, Bronx and Richmond. More recently the Brooklyn tuberculosis clinics have also organized along similar lines. The following recommendations concerning the conduct of clinics for the exclusive treatment of tuberculosis have been formulated by the Association of Tuberculosis Clinics of Xew York City, and are based upon the results of a year's careful intensive study of the work of the clinics belonging to the Asso- ciation. These recommendations have been grouped under appro- priate heads, and have to do with the general policy of admin- istration, the work of the nurses, the keeping of records, clinic facilities and clinic hygiene. An attempt has been made to fix a minimum working stan- dard to which tuberculosis clinics should conform in order to accomplish their work with the greatest expedition and with the least possible danger of infection to physicians and nurses or patients applying for examination who may not be tuberculous. It is hoped that these recommendations may be helpful to clinics that may hereafter be established as well as to clinics al- ready in operation. Floor plans of clinics showing a separate building devoted exclusively to tuberculosis patients afe appended, also sample signs and record cards used in the Department of Health Clinics and several private clinics and recommended by the Association for all clinics included in its membership. GENERAL POLICY OF ADMINISTRATION. The following conditions are necessary for admission to membership in the Association of Tuberculosis Clinics and should be considered as fundamental requisites for all special tuberculosis clinics. a. All tuberculosis cases must be segregated from other dis- pensary patients and treated in a separate class. b. A graduate nurse must be assigned to this class for the purpose of maintaining supervision over the homes of these tuberculosis cases. c. The work of the class for new cases must be limited to the particular district assigned to it. Each clinic should arrange for a physician to visit and treat in their homes those cases who are too ill to attend the clinic and for whom hospital care cannot be provided. Special provision should be made for the treatment of chil- dren by the establishment of children's clinics wherever the size of the clinic would seem to warrant it. "Special class" work should be introduced into ■ all large clinics by classifying patients and treating them in separate small groups. The sputum of every clinic case should be re-examined once a month. All cases should be re-examined at least once a month and the result entered on the records. The physicians should use the nurse's report of home condi- tions as a basis for advising patients. Any patient refusing for any reason to attend his or her proper dispensary, who is not under the care of a private physi- cian, should be considered a delinquent case. Such cases absent- ing themselves for one month from their clinic should be dis- charged as "delinquent" cases and reported to the Department of Health. Clinics connected with general hospitals should endeavor to secure a few beds therein for the use of clinic patients in emer- gencies or while being held under observation for diagnosis, e. g., during the administration of the tuberculin test. NURSES. All supervising nurses should be affiliated with some local relief organization in order to better organize the relief work of me clinic. All nurses engaged for work in tuberculosis clinics should have had training in social work. There are Schools of Phil- anthropy for the training of social workers throughout the country, having special courses, which are highly desirable for nurses wishing to take up tuberculosis work. If nurses are employed who are without training in social work, it is advisable that during the first month of their em- ployment by the clinic, they should give a certain portion of their time to the work of one of the recognized large relief societies. Previous experience in tuberculosis work, while not essential, is a distinct advantage. The home of every patient should be visited at least once a month. A clerk should be provided in those clinics where the clerical work of the nurses interferes with their more specific duties. RECORDS. Where two or more clinics are established in a given locality a uniform system of record keeping and record filing should be adopted. The classification of the National Association for the Study and Prevention of Tuberculosis should be employed for record- ing the stage of disease and condition on discharge. A record of the condition on discharge should be kept for all patients. A uniform system of record keeping should be used by nurses in order to facilitate the compiling of monthly reports. CLINIC FACILITIES. Space : When a tuberculosis clinic does not occupy a special building used for no other purpose it should be separated as far as pos- sible from the other parts of the dispensary. The tuberculosis clinic proper should have not less than three rooms, one for interviewing and two for examining patients, one for men and one for women. In case the clinic room or rooms are not available outside of clinic hours, another room should be available for private con- ferences between the social worker or nurse and those patients requiring relief. In connection with the clinic there should be separate closets, one for physicians' and nurses' coats and one for the gowns w T orn by physicians and nurses and for the necessary clinical supplies. Equipment : The interviewing room should contain a sink with hot and 4 cold water, at least two desks or tables, (one for the physician and one for the nurse), a filing cabinet for records, scales, extra chairs or benches for use of patients while waiting to have tem- perature and pulse taken, a suitable receptacle for soiled gauze or paper handkerchiefs, a metal screen and a map showing the various clinic districts. Where a special room is not available for the examination and treatment of throats, a screened-off portion of the interviewing room should be fully equipped for this purpose. The use of the interviewing room, where both men and women are received, is recommended rather than either one of the examining rooms where patients may be disrobed and awaiting examination, in which case the room would not be available for patients of the opposite sex. Each examining room should contain an examination table, chairs, metal screens and sink with hot and cold water. Staff: The number of physicians in attendance should be sufficient to allow at least 15 minutes for the examination of every new case exclusive of the time given to history taking, and at least six minutes to the examination of every old case. The payment of salaries to physicians will aid materially in securing and keep- ing desirable men for tuberculosis clinic work. There should be at least one nurse for every 100 patients on the clinic register. CLINIC HYGIENE. Tuberculosis cases while awaiting admission to the clinic rooms should be separated from the other dispensary patients, either in a separate waiting room or in a separate portion of the general waiting room. In all waiting rooms for tuberculosis patients, large signs m several languages should be displayed, giving detailed informa- tion as to caring for the sputum. Sputum cups or a proper substitute therefor should be fur- nished by each clinic to patients to take home. Either paper or gauze handkerchiefs should be given by the Registrar or Clerk to each patient at the time of his admission for use at the clinic. Suitable receptacles should be provided in the waiting room and in each clinic room for soiled paper or gauze handkerchiefs. No cuspidors should be used. Sanitary drinking fountains or sanitary paper drinking cups should be provided for the use of tuberculosis patients. Furniture, as well as floors, should be washed daily. Gowns with sleeves should be worn by physicians while on duty in the clinic rooms. Nurses should wear either gowns with sleeves or washable uniforms while on duty in the clinic rooms. Patients' mouths should be covered during the time they are being examined by the physicians. Capes of washable material should be provided for each patient while disrobed and awaiting examination. Floor Plans and Sign FLOOR PLAN OF A HEALTH DEPARTMENT TUBERCULOSIS CLINIC. 8 "Rao rr. 3SOSj. f +... 4/3" SPEC It Clinic. Women's . Clmie. lam. ' 1 14 S J* o S C/J cd ■*-» S CA o o S >» 25 S cv e > • p« o Sm o 3m o 0) bo © V pJC o H-» "W <*m ■*-» "T3 • PM «J Sm 4) ss o »M © & -G 9m O V4M _* ■*-» 0) q cd © >> e © >M cd >M 0) be e a, •4-1 • p« • M a> • u • PM & • MX „, a cd o MM -S3 s • PM »PM 0) © u cd CD pJC v»m o 1m bo *-£3 •M Q 0) cd ■M* 2 "© o a a • *M a> 3 X ■4M bo cd -a (A bo O S N 0) 0) c a* a> a. cd "© a CiQ cd O C/3 a. a cd bo cd SQ 9 O >< O © bo PM • IM CD C 4J 4-1 e 0) .JO 1m s • »M *-» *-» • pM Cm 0) (J 9U Cm PM cd ^ e a. CO cd fiu CD IO Sample Records and Reports 12 13 14 m s z ID to 1- (A £ U) a. < E > u E h z UJ D a hi U) m D tfi 1 K" z Z kl O S H E 1- o -1 H Q 15 i6 17 O -x ^ CO h 3 J 5. r. 1- Z Ul 44 < Q. 1 co G li. ON tf) s LI c c li. )r o I ol 3 1^ «■ "4. Is •4. 18 i9 ASSOCIATION OF TUBERCULOSIS CLINICS OF THE CITY OF NEW YORK St Lukes REPORT OF THE Clinic for the Month of - Jmne. Patients Receiving Treatment- Under Observation 1st of llonth- New Cases Old- Cases Re- Admitted- iao -L2- 20 5 ^LL _A±. 1911 _£_£_ £4-7 Patients Discharged. _L2L * Patients Remaining Under Observation Last Day of Month Visits of Patients to Clinic During Month JJEUL _4^i. ilSL 34- 26 173 4-7 Patients Receiving Extra Diet- Patients Referred by Non-Association Hospitals and Dispensaries _ 3L2JB-. _L£L2L 24-6 *0f these 6 6 msfH are suspicions and have not been reported to the Department of Health. Patients Discharged Condition on Dischaboe : (Patients tender treatment 1 month or more) Apparently Cured__Q__Arrested t _Improved__<2 Progressive- Died_CL_Not Tuberculous i Undiagnosed Q -Tota Stage of Disease at Time of Admission: (Patients under treatment 1 month or more) Incipient_5___Moderately Advanced 4 ZFar Advanced ± Doubtful O Not Tuberculous _i , . TotaL. DuBATION OF TbEATMENT 2-29 Days-J> 1 to 3 Mo._£L— 3 to 6 Mo._ 2 to 3 Xrs._Q_3 Yrs. and over_Q_ Came Once . Reasons foe Dischabge Unwilling Q Too Feeble Q_ Working Q Not Found L -2. 1 to 2 Yra._0 -Total— l^- _Moved__H__Not Tuberculous 1 In Hospital E , In Sanatoria_4l- Transferred 3__ In Other Care_L -Left City__sL_ -Apparently Cure -Attending Non-Association Dispensary °_ J?_Arrested__ 1 Died Q. Total 1? Eespectfully submitted, SZrOfi^l&siS MONTHLY REPORT OF CLINIC TO ASSOCIATION. (Reduced — Actual size 8% by 11 inches.) 20 DIRECTORS AND OFFICERS. James Alex. Miller, M.D., President John H. Huddlestox, M.D., Vice-President Lawrence Veiller, Secretary Mrs. Hermann M. Biggs F. IvlGRRIS ^LASS, M.D. Mrs. J./ Borden Harriman Austin W. Hollis, M.D. A. ]s toBi, M.D. Miss/ Blanche Potter Antonio Stella, M.D. b/h. Waters, M.D. Fraxk H. Mann, Assistant Secretary F. Elisabeth Crowell, Executive Secretary 21 COLUMBIA UNIVERSITY LIBRARIES This book is due on the date indicated below, or at the expiration of a definite period after the date of borrowing, as provided by the rules of the Library or by special ar- rangement with the Librarian in charge. DATE BORROWED DATE DUE DATE BORROWED DATE DUE C28II 14OIM1O0 RC 309 .1143 As 7 Association of tuberculosis clinics