Authors (including presenting author) :
Chu LYJ(1), Tsang YSM(2), Ng WSV(3), Chow KM(1)(3)
Affiliation :
(1) Quality & Safety Division, Prince of Wales Hospital
(2) Quality & Safety Division, Alice Ho Miu Ling Nethersole Hospital
(3) Medicine & Therapeutics, Prince of Wales Hospital
Introduction :
Barrages of researches depicted that burnout of frontline medical, nursing professions might undermine quality of patient care. According to a local survey in 2020, the prevalence and severity of burnout in Hong Kong doctors up to 20 years’ post-graduation was 55.9%, which was work-related and 35.4% patient related. One of the factors in overwhelming medical, nursing professionals in clinical settings was reading enormous normal laboratory results which turn out to desensitize the alertness in critical results.
Objectives :
Since 27 August 2020, the “No printing of selected 22 items of normal laboratory results” has been piloted in some areas in PWH (SOPCs of ENT, O&VS, O&T, OMCS, Oncology, M&T, Surgery, some FM clinics). The selected items include CBP, ESR, R/LFT, bone profile, Cardiac enzymes, amylase, Gamma-GT, etc. Since 14 Oct 2020, this program extends to AED. Evaluation of outcomes including percentage of suppressed reports as well as opinion survey from frontline staff would help us to determine the way forward.
Methodology :
Related incident rate after implementation of this program was reviewed. Data of suppressed laboratory reports from chemical pathology and haematology were obtained to evaluate the effectiveness of the present program. An anonymous online opinion survey was sent out in Dec 2020 to collect feedbacks from frontline doctors, nurses and clerical staff. Likert scale of (1-10± standard deviation) was used to rate of helpfulness of this program in reducing workload, and in what way does this program helped. Self-reported number of hours reduced was also obtained. Further inspiration on improvement was explored.
Result & Outcome :
No incident has been reported related to missing of abnormal laboratory results after implementation of this program. The total percentage of suppressed reports in chemical pathology was 34%, with maximum reduction of reports in OMCS (56%), O&T (54%), O&VS (46%) and AED (42%).
The total percentage of suppressed reports in haematology was 4%, with maximum reduction in ENT (20%), O&VS (16%) and O&T (15%) SOPCs.
Completed surveys were collected from 38 medical staff, 40 nursing staff and 31 clerical staff. On average, rate of helpfulness rated from medical staff was 7.2±1.6, that from nursing staff was 6.4±2.1 and that from clerical staff was 6.5±1.7. On average, the number of work-hours reduced as self-reported by medical staff was 1.6±1.0 hours (range: 0.5-4 hours), that by nursing staff was 1.7±1.0 hours (range: 0.6-2.9 hours), that by clerical staff was 2.7±2.9 hours (range: 0.8-9.7 hours). In terms of paramountcy of this program in helping clinical work, 32% of staff thought this program let them more concentrated on abnormal results, 30% of staff thought the program could let them spend more time in other clinical activities, while 28% of staff thought this program speed up the follow-up actions of abnormal results.
Some staff also portrayed there was an urge to extend this program to other clinical areas or to other radiology reports like ultrasound. Some would like to have a system with “mark read” function for doctors to screen reviewed results, adding of more laboratory tests in this non-printing program, etc. After this evaluation of the program, we rolled out the second phase of this program to cover locations/departments not involved in the first phase in Jan 2021, which involved Staff & GS clinic under Family Medicine, Department of psychiatry, etc. Also the program will be rolled out to AHNH & NDH gradually to ease the workload of frontline professionals.
