Authors (including presenting author) :
Yiu CH(1), Lam MK(1), Ng ML(1), Lau TT(1)
Affiliation :
(1) Out-Patient Department, Our Lady of Maryknoll Hospital
Introduction :
Specialist Out-Patient Clinic (SOPC) service at Hospital Authority is part of secondary care in Hong Kong mainly provides specialist care to patients in an out-patient setting with referral from medical practitioners. OLMH SOPC provides specialist services to patients including the specialties of Internal Medicine, Surgery, Gynecology, Pediatrics, Orthopedics and Ear, Nose & Throat. Since 2004, HA has adopted a triage system for newly referred SOPC cases. According to the clinical triage guidelines of Hospital Authority, referrals of new patients should be triage into priority 1 (urgent – seen within 2 weeks), priority 2 (semi-urgent – seen within 8 weeks) and routine (stable) categories. New case booking is based on triage criteria in individual hospital for categorization of priority. It is to ensure that patients with urgent conditions which need early intervention can be arranged timely and properly.
Objectives :
Over the past years, the screening mechanism for new referrals in OLMH was firstly triage by SOPC nurse according to the triage criteria of different specialties. The triage categories will then be revised by a specialist doctor of the relevant specialty within seven working days. As a result, most of the first appointment needed to be changed after reviewing by specialist doctor. In 2019, there were 9876 new case bookings. Patients felt frustrated and even angry if the new referrals were not classified as priority 1 or 2 on the day of booking first appointment. In order to unique and simplify the screening mechanism for new referrals of different specialties, a program on ‘Streamline the workflow for triage and new case booking in SOPC is implemented in September 2019.
Methodology :
SOPC adopt another triage workflow with reference to ‘Hospital Authority SOPC Operation Manual 2018’. According to this workflow, patients would only be offered a first appointment after the triage by specialist doctors within seven working days from the day of receiving new referrals. After the triage, SOPC staff would phone to the patients of the new referrals which had categorized as priority 1 and 2 and inform of the first appointment. For the new referrals which had categorized as routine, appointment slip would be sent out to patients. Nurse manager of SOPC coordinated with doctor consultants of the six specialties in OLMH and introduced the new triage workflow in June 2019. After discussion with the doctors of different specialty, they all agreed to adopt the new triage workflow with effective from September 2019.
Result & Outcome :
The objective of the program is to standardize the triage workflow for each specialty, it aims at shortening of the queuing time for booking first appointment in SOPC counter and minimize enquiries and confusion from patients on changing of the first appointment date. It also helps clerical staff to handle new case booking more effectively and efficiently. A satisfaction survey from SOPC staff including nursing, clerical and patient care assistant is done in December 2019 as to collect feedback. There are total of 43 questionnaires were being collected. Clerical staff feedback that the booking time for new case appointment is shortened from around 8 -10 minutes to around 3- 4 minutes. It is very encouraging that it is not necessary to give a lengthily explanation on the possibility of changing of appointment and answered enquiries on the long waiting time of first appointment. From the questionnaires, over 90% staff strongly agree and agree that the program helps to minimize conflicts between SOPC staff and the patients concerning the date of first appointment, minimize patient confusion on changing of the first appointment, minimize the number of enquires. Streamline and simplify the workflow actually helps to enhance staff efficiency on new case booking and helps to advocate a more harmonized environment in SOPC.
