01 Jul 2010
Each time 33-year-old thalassaemia patient Felicia Chan (not her real name) needed a blood transfusion at Singapore General Hospital (SGH), she would take two days off work.
Every step in the transfusion process – a consultation at K Clinic, two rounds of blood tests, cross-matching at the Blood Bank, and delivering and verifying blood packs at the Haematology Centre – involved long waiting times. On good days, Ms Chan, whose inherited blood disease causes anaemia, was only able to leave the hospital at 7pm. More often than not, however, she had to return the following day to resume her transfusion.
She was not the only one. Some patients had to wait more than half a day, and nearly half had to stay in hospital till after 6pm to complete their transfusion, requiring nurses to work overtime.
A Quality Improvement project initiated by SGH, however, turned the situation around. By May 2009, 92 percent of patients (up from 49 per cent) faced a waiting time of 4.5 hours or less.
The success of this initiative earned the multi-department team behind it the SingHealth group’s 2009 Best CPIP (Clinical Practice Improvement Project) Award, and the NIQCC (National Innovation and Quality Circles Convention) Silver Award 2009.
Led by Ms Tan Chor Kien, the team brought together staff from SGH’s K Clinic, Blood Bank, Transportation Unit, Department of Haematology and the Haematology Centre. The team also consulted patients such as Ms Chan to get patients’ perspectives on the situation. Said Ms Tan, Nurse Clinician, Haematology Centre: “Long waiting times had been an ongoing problem since the Centre was set up.
In November 2008, we decided something had to be done for patients like Ms Chan.”
The team studied the problem over six months, identifying the various stages where delays were occurring. For instance, at K Clinic, each patient underwent two separate rounds of blood sampling, a process which the team felt could be shortened.
According to K Clinic’s Senior Staff Nurse Yeam Shin Yen, patients had their blood tested upon registration. After seeing the doctor and if a transfusion was required, a second blood sample was taken and sent to the Blood Bank for urgent processing. The two-hour cross-matching time at the Blood Bank could not be shortened for safety reasons, but the team observed that samples that arrived there were not marked in any way to identify them as priority specimens.
In addition, there were patients who could have their blood transfusion done in one day but who were not identified upon registration.
To streamline the process, potential candidates for same-day blood transfusion (indicated on their appointment cards) now have two blood samples taken after registration. Should they need a transfusion, these patients don’t need to wait to have a second blood sample taken, but have a sample ready to be dispatched to the Blood Bank. To alert Blood Bank staff that the blood samples need to be urgently processed, they are sent in a red folder unique to K Clinic specimens.
Communication lines have also improved. Previously, once a compatible match was found, the Blood Bank would inform the Haematology Centre, which called or faxed the Transportation Unit to pick up the blood packs. The team did away with this roundabout system and installed an e-Porter system at the Blood Bank, resulting in the blood packs arriving at the Centre in a much shorter time.
The team’s efforts did not go unnoticed by patients, with a post-project survey showing that 97 per cent of patients rated the improvements as “very good to excellent”. Staff morale at the Centre also improved, as working beyond 6pm became rare. Said Ms Tan: “The success of this project is a good reflection of what collaborations between staff from different departments can achieve.”
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