Chong Wesley, Fong Allan Chee Yang, Yeo Yi Lin, Ng Angie Puay Hong, Neo Eileen May Lin, Sam Veronica Li Ee, Ong Jessica Kai Jun, Huey Peng Loh
General Cataract and Comprehensive Ophthalmology, Singapore National Eye Centre, Singapore.
Clinical Audit, Singapore National Eye Centre, Singapore.
BMJ Open Qual. 2018 Mar 14;7(1):e000167. doi: 10.1136/bmjoq-2017-000167. eCollection 2018.
To reduce the number of invalid surgical consents in the Singapore National Eye Centre Day Surgery Unit over a period of 6 months.
A multidisciplinary team involving doctors, nurses, day surgery unit, operating theatre, listing and clinical audit staff looked into the listing process and the root causes of the high number of invalid consents. A Pareto chart detailing the top causes of invalid consents was drawn, and with a prioritisation matrix, feasible yet effective changes were identified and effected. Plan-Do-Study-Act (PDSA) cycles included moving consent checks upstream, getting invalid consents amended on the same day, sending emails to raise awareness on invalid consents and posters in clinics to emphasise the correct way to fill up consent forms.
There has been a progressive downtrend in the monthly mean percentage of invalid consents since the introduction of PDSA cycles. There was a significant reduction in the mean rate of rejected consents from the preintervention phase of 15.2% to the postintervention phase of 11.3%, shown with a Z score of 6.56 (P<0.05). Sustainability was also demonstrated with multiple consecutive points below the median of 14.5% on the postimplementation phase of the run chart, with estimated time-efficiency savings of USD$19 738.50 annually.
Errors in the workplace can be reduced with a concerted effort from multiple stakeholders. It is important to have a thorough look at processes with concerned parties, so that different perspectives and skill sets can be harnessed to determine and implement feasible and effective interventions.
在6个月内减少新加坡国家眼科中心日间手术部无效手术同意书的数量。
一个由医生、护士、日间手术部、手术室、排期人员和临床审计人员组成的多学科团队研究了排期流程以及无效同意书数量众多的根本原因。绘制了一份详细列出无效同意书主要原因的帕累托图，并通过优先级矩阵确定并实施了可行且有效的改进措施。计划-执行-研究-行动（PDSA）循环包括将同意书检查提前、当天修改无效同意书、发送电子邮件提高对无效同意书的认识以及在诊所张贴海报以强调填写同意书的正确方法。
自引入PDSA循环以来，无效同意书的月度平均百分比呈逐步下降趋势。拒绝同意书的平均比率从干预前阶段的15.2%显著降至干预后阶段的11.3%，Z值为6.56（P<0.05）。运行图实施后阶段的多个连续点低于中位数14.5%，也证明了可持续性，估计每年节省时间效率19738.50美元。
通过多个利益相关者的共同努力，可以减少工作场所的错误。与相关方全面审视流程非常重要，这样可以利用不同的观点和技能来确定和实施可行且有效的干预措施。
