1. BACKGROUND By adopting different injection dosage and techniques, Botulinum A toxin (BOTOX®) injection is useful in treating a wide range of ophthalmic diseases including essential blepharospasm, hemifacial spasm, lid myokymia and lid retraction. Despite its effectiveness, each injection only provides temporary relief (~3-4 months) to these chronic functionally/ cosmetically disabling disorders. Therefore, the number of patients requiring injections has substantially increased throughout these years in our unit. aims The aims of the current project: 1. Streamline the existing booking system to reduce non value-added workload 2. Retain the advantage of current system: Minimize drug wastage by grouping patients into a designated clinic and estimating total drug dosage required CURRENT CONDITION PROBLEM ANALYSIS TARGET CONDITION IMPLEMENTATION PLAN FOLLOW UP 0.88 working day 3.81 working days Each year (with 6 Botox clinic), the new booking system will save 0.88 working day for doctors and 3.81 working days for Appointment counter/MRO colleagues (only include actual working time and not yet include waiting time between each steps and among different parties) Other benefits yielded: New form designed for booking system can be used for time out on injection day Patients were informed of injection date and time in advance on the day of listing Drug dosage can be calculated more accurately No record will be kept by doctors before injection for drug calculation Follow up actions undergoing: Monitor the number of patients for Botox injection and consider arranging monthly injection if number continues to increase or exceeds quota available Title: Streamlining Botox injection booking Leader: Dr. Noel CY Chan Sponsors : Dr. Stanley CC Chi, Dr. Ben NM Lam, Dr. Hunter KL Yuen Facilitator : Dr. Andy CO Cheng Members: Dr. Carmen Chan, Dr. Jasmine WS Ngai, Mr. Tony Lam, Ms. Tracy Mak Start Date: 1 April 2011 End Date: Last Updated: 24 Aug 2011 ID: List next Botox appointment in OPD Keep gum label onto record book Patient wait for phone call On Booking Day for Botox injection Date of botox injection selected & released Receive date & pull out record list Receive list & contact MRO Retrieve records according to the list Screen all records for indication Call patients & confirm list Calculate drug dosage Pharmacy order drug Doctors informed for final list Patients receive calls & indicate availability BOTOX INJECTIONBOTOX INJECTIONBOTOX INJECTIONBOTOX INJECTION BOTOX INJECTIONBOTOX INJECTIONBOTOX INJECTIONBOTOX INJECTION 1 month before Botox injection 120 minutes 180 minutes 60 minutes 5 minutes List next Botox appointment in OPD Book into computer system on designated date (Newly designed form allows input of indication) Patient receive appointment slip for next injection On Booking Day for Botox injection 60 minutes 5 minutes 2 weeks before Botox injection Pull out computer list Retrieve records Calculate drug dosage Pharmacy order drug BOTOX INJECTION ActionResponsibleDeadline Design new botox injection form (Month of injection, Indication for injection) J NgaiApr 2011 Design electronic profile for booking systemN Chan, T LamApr 2011 Generate quota for designated datesT MakApr 2011 Inform responsible staff on new booking form & system & Trial run of system J Ngai, N ChanMay 2011 Full implementation of booking system and formN ChanJuly 2011 90 minutes 30 minutes For each botox clinic bookingBeforeAfterReduction Number of steps1376 Working time by doctors (mins)75570 Working time by Appointment counter/ MRO (mins)39590305 5 minutes Doctors Appointment office Patients MRO Pharmacy * Time used for preparation of one session of Botox injection Patients grouped into one clinic to minimize drug wastage Expensive drug & limited stock Date of injection depending on doctors’ availability Diversity in hand written diagnosis in record Temporary effect of BOTOX leading to repeated injections Increasing number of patients requiring injection regularly Lack of electronic profile in booking system for Botox injection Multiple non value- added steps in booking Botox clinic Injections for different diagnosis require different dosage Only a few doctors were equipped with injection techniques On average: about 30 patients/ each session of Botox injection