Authors (including presenting author) :
Lui TC (1), Chu CK (1)
Affiliation :
(1)Community Nursing Services, Kowloon Hospital
Introduction :
KH CGAT need to manage a large volume of Medical Assessment Forms and referrals every year. Both are vital document that enables doctors to provide timely care. According to record, KH CGAT received ~ 4,100 MAFs from SWD and ~950 referrals from GOPD, SOPD or wards in 2018-2019. The referrals or MAFs were sent to CGAT via staff of RCHEs. However, RCHEs have their own practice, there was no standardize practice on referrals or MAFs management. As a result, the referrals or MAFs could not be delivered to CGAT in a timely manner. According to record, total missing or delay referrals or MAFs in 2018-2019 were 48 and 36 respectively.
Objectives :
The goal is to streamline communication among referring organizations, CGAT, & RCHEs. Objectives included i) ensuring referral or MAF can be delivered to CGAT without delay, ii) eliminating missing referral / MAF, iii) ensuring continuity of care, & iv) standardizing practice on referral or MAF management.
Methodology :
Outcome measurements included the no. of incidents, i.e. delay or missing referrals and MAFs (pre / post), satisfaction survey of CGAS nurses and RCHEs’ staff (pre /post). The project was implemented in 3 phases: 1)Planning: 19/11 - 3/12/19 - formation of workgroup on 19 November 2019 - preparatory meeting was held on 19 November 2019 - collected data on the no. of incidents i.e. delay or missing referrals and MAFs; - Used fishbone tool for root cause analysis - conducted satisfaction survey - development of written instruction and standardized form for referral management and record respectively - preparation of folders and zip bags to RCHEs 2) Pilot in 3 RCHEs: 4/12 - 23/12/19: - Discussed with RCHEs about the severity of referrals problem - on-site support by CGAT - Project review on 23 December 2019 3) Full implementation in 23 RCHEs: 24/1219 – 24/3/20 - Discussed with RCHEs about severity of referrals problem. - on-site support by CGAT - Monitoring of no. of incidents - Conducting satisfaction survey
Result & Outcome :
When Aug 19 – Oct 19 was solely compared to Dec 19 – Mar 20, there is a remarkable 100% reduction in the number of incidents related to missing or delay referral / MAF.Time spent on the process of handling the received referral & MAF was reduced from 1070 sec to 680 sec (~37%). Nurse can use the saved time to do more patient’s assessment (600 sec/ patient) . If the saved time is 1950 sec per day, 3 more patient’s assessment can be done.
