01 Jan 2011
A new workflow at Singapore General Hospital’s (SGH) Department of Orthopaedic Surgery has dramatically reduced the waiting time for patients undergoing pre-surgery tests.
But that’s not the only thing that has gone down – costs have also been reduced.
By equipping senior nurses with indepth skills, centralising tests and consultations needed by patients and educating patients on their specific conditions, the department has managed to significantly cut down patients’ waiting time.
Before, patients typically spent about five hours on pre-operative assessments and consultations.
Now, it is just one and a half hours – a reduction of more than three hours that has significantly raised patient satisfaction.
Each year, the department performs more than 4,000 surgeries. In 90 per cent of these cases, patients have their preoperative assessments performed at the outpatient clinic, instead of when they are warded.
While patients saved on bed and other charges, they had to walk to different places in the hospital for the assessments, which include blood tests, x-rays, anaesthetist consultation, financial counselling and education by orthopaedic nurses.
They often spent time waiting at each station.
To address complaints, a team of 10, including specialist nurses, was formed in August 2009. Led by Ms Chew Sheh Li, Nurse Clinician, Department of Orthopaedic Surgery, SGH, the team identified three main problems:
a shortage of manpower at some stations, consultation and testing stations scattered around the hospital, and waiting time at each station, with nurses spending time with patients to ensure they understand their condition.
“Most patients’ complaints were about the waiting and travelling time between stations. We studied best practices across several industries, with companies like Toyota, SIA Cargo and Housing and Development Board where services were integrated to provide a lean working environment,” Ms Chew said.
As a first step, advanced practice nurses who typically have Masters in Nursing were asked to shadow senior doctors to get more in-depth skills. They were also trained to answer patients’ questions such as how long they can expect to stay in hospital, the risks of surgery and types of step-down facilities available.
Patients were also given comprehensive pamphlets on their condition, with frequently asked questions such as why the surgery is needed and what it entails.
Lastly, registration staff were trained to counsel patients on bills and other finance-related issues, and two rooms were set aside for medical staff to hold preoperative assessments and consultations with patients.
Going to another clinic for this consultation, and waiting to see an orthopaedic doctor for assessment were hence eliminated, said Ms Chew.
The team conducted a survey after implementing these changes and found that the majority of patients were satisfied with the new arrangement.
As a result of time saved in waiting, patients saved on carpark fees and hourly wages lost.
“There was less frustration among patients. The shorter waiting times helped relieve their fear, anger and anxiety too.
There is also less movement of patients between departments as everything is under one roof,” said Ms Chew.
The project won a Star award in the Team Excellence Symposium – Innovation & Quality Circles (In-house) Assessment.
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