qmmc- emergency room ophthalmology dept operations management bolintiam, cruz, rivera, valera july...
TRANSCRIPT
QMMC- Emergency RoomOphthalmology Dept
Operations ManagementBolintiam, Cruz, Rivera, Valera
July 04, 2011
The QMMC Ophtha ER
• Opens after Ophtha OPD hours (5 PM- 8 AM the following day)
• Manned by an intern and the Resident-on-Duty
• Provides emergency medical and surgical Ophtha care
• Would attend to patients with complaints in the ff areas (upper half of the face)
- Eye - Eyebrow - Lower lid
CURRENT PROCESS FLOWCHART
Initial Assessment at
the triage
Refer to other departments
REFER TO OPTHA
YES
NOProblems
on the upper half of the face
(eye, eyebrow, lower lid
Refer to Optha
Initial Assessment by
the Intern
Patient referred to resident
Secondary Assessment of
the resident
Resident manages the
case
Secondary Assessment of
the resident
Other problem
?
Refer to other departments
Patient Discharged
YES NO
THE PROBLEMS
Magnitude-Response-Importance-Urgency (MRIU)
PROBLEMS Frequency/ days (number of times)
EFFECT TO OPERATION
Inefficient Triage System (e.g. incomplete data, wrong referrals)
1 Ophtha had to unnecessarily assess the patient again.
Patients get lost going to the ophtha ER
2 Patients get lost going to the ophtha ER Delays patient care
Lack of materials or diagnostic tools in the ER to be able to assess the condition of the patient
2 Clerk or resident has to go to the OPD to get the diagnostic tools needed while the patient waits
Magnitude-Response-Importance-Urgency (MRIU)
PROBLEMS Frequency/ days (number of times)
EFFECT TO OPERATION
Resident on duty cannot be contacted and cannot be found in his quarters
4 The clerk or intern spends time trying to call the resident in his celphone or trying to page the resident. The clerk or intern also has to roam around the hospital to look for the resident if he is not found in his quarters
Slit lamp becomes difficult to maneuver/use
4 Resident has to reset and re-adjust the slit lamp everytime it becomes defective and this causes delay in patient assessment and care
Magnitude-Response-Importance-Urgency (MRIU)
PROBLEMS Frequency/ days (number of times)
EFFECT TO OPERATION
No available sutures/gloves/gauzes to be used for managing trauma cases
4 Patient or relatives have to buy materials before the patient is managed. The resident cannot do anything to manage the patient without materials for suturing
OBJECTIVE
Objective
•To improve patient’s satisfaction▫To reduce patient’s waiting time by at least an
hour▫To increase efficiency by at least 50%
SOLUTIONS
Process Improvement flowchart
FINAL RECOMMENDATIONS
• Intermediate range planninga. Purchase special equipment that will be for ER
use onlyb. Provide more chairs, stretchers, and beds for
the patientc. Purchase medical supplies for the ERd. Duty phone and extra beds for residents-on-
dutye. Create Clinical Pathways to guide those who
are in charge of the triage for appropriate referral
f. Add manpower in the triage area
FINAL RECOMMENDATIONS
• Intermediate range planninga. Duty phone and extra beds for residents-on-
dutyb. Create Clinical Pathways to guide those who
are in charge of the triage for appropriate referral
c. Add manpower in the triage area
FINAL RECOMMENDATIONS• Short range planning
a. Implement rule on resident’s maximum call time• Residents are expected to be in the ER most of the
time.• In special cases, residents are required to be in the
ER within 15 minutes after the referral.• Stricter rules regarding residents (and even interns)
who are out-of-posts• Penalties/Incidental Reports if they are not able to
comply with rules
FINAL RECOMMENDATIONS• Short range planning
b. Improve triage• Initial history and PE should be done in the
triage.• Vital signs and pertinent history• Priority given to emergency and urgent cases.• Patients with non-urgent cases can be
attended only after all emergency and non-urgent cases are managed.
c. Put up Signs that will lead patients going to ophtha ER and to other departments
CONCLUSION•Reduce 10 mins from waiting to be
assessed by the triage
•reduce 3 mins from looking for ophtha ER
•reduce 4 mins waiting time for clerk to prepare materials
•reduce 40 mins waiting time for the resident to arrive
CONCLUSION
•reduce 5 minutes from the resident diagnosing the patient
•reduce 40 minutes from the patient having to provide the materials needed for emergency surgery
•reduce 102 minutes total • 162-102= 60 minutes (1 hour)
Thank youEND