Ho Emily Tse Lin
Singapore General Hospital.
BMJ Qual Improv Rep. 2014 Feb 5;2(2). doi: 10.1136/bmjquality.u201918.w1006. eCollection 2014.
The Singapore General Hospital Diabetes Centre (DBC) is a multidisciplinary specialist outpatient clinic which aims to provide an integrated one-stop service for diabetes. As with many tertiary academic centre clinics, DBC encounters an expanding patient load, greater patient expectations and increasingly complicated patients who require services from a multitude of health providers. Such rising demands amidst limited resources cause inefficiencies and long waiting times to consultation. This result in low patient satisfaction and an unpleasant clinic experience. A multidisciplinary team was formed to reduce the waiting time at DBC and improve communication and work processes of staff. Addressing wait-times is complicated as multiple stakeholders and operational processes are involved and interlinked. By systematically breaking down processes and identifying problem areas, targeted changes were implemented. This included a revised model of appointment scheduling, a patient reminder system, more effective communication sheets and work reassignments. The primary aim of this project was to improve the patient turn-around time (duration a patient spends at the centre for a visit). There was no documented improvement in turn-around time after project implementation (108.23 minutes versus 106.6 minutes) but other secondary aims were achieved. These included an increase in the percentage of patients seen by the doctor within 60 minutes from 80% to 84%, a reduction in wait-time for payment and reappointment at the cashier by 36.6% and a reduction in non-attendances of new cases to the clinic from 30.2% to 21.3%. Staff satisfaction and communication were greatly improved. To aid sustainability, personalized reports of individual doctor's waiting times and workload were produced quarterly and tracked. As this is a first step quality improvement project, efforts to track, examine and further improve turn-around times are on-going. Future initiatives are directed at time-efficient appointment scheduling between care providers for same day appointments, a reactive SMS system for reminders and reappointments and optimization of processes and manpower allocation for clinics.
新加坡中央医院糖尿病中心（DBC）是一家多学科专科门诊诊所，旨在为糖尿病患者提供一站式综合服务。与许多三级学术中心诊所一样，DBC面临着不断增加的患者数量、更高的患者期望以及越来越复杂的患者，这些患者需要众多医疗服务提供者提供服务。在资源有限的情况下，此类需求不断增加导致效率低下和就诊等待时间过长。这导致患者满意度较低以及不愉快的就诊体验。为此组建了一个多学科团队，以减少DBC的等待时间，并改善工作人员的沟通和工作流程。由于涉及多个利益相关者和运营流程且相互关联，解决等待时间问题较为复杂。通过系统地分解流程并确定问题区域，实施了有针对性的变革。这包括修订预约安排模式、患者提醒系统、更有效的沟通表单以及工作重新分配。该项目的主要目标是缩短患者周转时间（患者在中心就诊一次所花费的时长）。项目实施后，周转时间并无记录在案的改善（从106.6分钟变为108.23分钟），但实现了其他次要目标。这些目标包括在60分钟内见到医生的患者比例从80%提高到84%，在收银台付款和重新预约的等待时间减少36.6%，新病例未到诊所就诊的比例从30.2%降至21.3%。工作人员的满意度和沟通得到了极大改善。为了有助于可持续发展，每季度生成并跟踪个别医生等待时间和工作量的个性化报告。由于这是质量改进项目的第一步，目前正在持续努力跟踪、检查并进一步缩短周转时间。未来的举措旨在实现护理提供者之间当日预约的高效预约安排、用于提醒和重新预约的反应式短信系统以及诊所流程和人力分配的优化。
