QMMC- Emergency Room Ophthalmology Dept Operations Management Bolintiam, Cruz, Rivera, Valera July 04, 2011

The QMMC Ophtha ER Opens after Ophtha OPD hours (5 PM- 8 AM the following day) Manned by an intern and the Resident-on-Duty Provides emergency medical and surgical Ophtha care Would attend to patients with complaints in the ff areas (upper half of the face) - Eye - Eyebrow - Lower lid

CURRENT PROCESS FLOWCHART

Initial Assessment at the triage Refer to other departments REFER TO OPTHA YES NO Problems on the upper half of the face (eye, eyebrow, lower lid

Refer to Optha Initial Assessment by the Intern Patient referred to resident Secondary Assessment of the resident

Resident manages the case Secondary Assessment of the resident Other problem ? Refer to other departments Patient Discharged YES NO

THE PROBLEMS

Magnitude-Response-Importance- Urgency (MRIU)

OBJECTIVE

Objective To improve patient’s satisfaction ▫ To reduce patient’s waiting time by at least an hour ▫ To increase efficiency by at least 50%

SOLUTIONS

Process Improvement flowchart

FINAL RECOMMENDATIONS Intermediate range planning a.Purchase special equipment that will be for ER use only b. Provide more chairs, stretchers, and beds for the patient c.Purchase medical supplies for the ER d.Duty phone and extra beds for residents-on- duty e.Create Clinical Pathways to guide those who are in charge of the triage for appropriate referral f.Add manpower in the triage area

FINAL RECOMMENDATIONS Intermediate range planning a.Duty phone and extra beds for residents-on- duty b.Create Clinical Pathways to guide those who are in charge of the triage for appropriate referral c.Add manpower in the triage area

FINAL RECOMMENDATIONS Short range planning a.Implement rule on resident’s maximum call time Residents are expected to be in the ER most of the time. In special cases, residents are required to be in the ER within 15 minutes after the referral. Stricter rules regarding residents (and even interns) who are out-of-posts Penalties/Incidental Reports if they are not able to comply with rules

FINAL RECOMMENDATIONS Short range planning b.Improve triage Initial history and PE should be done in the triage. Vital signs and pertinent history Priority given to emergency and urgent cases. Patients with non-urgent cases can be attended only after all emergency and non- urgent cases are managed. c.Put up Signs that will lead patients going to ophtha ER and to other departments

CONCLUSION Reduce 10 mins from waiting to be assessed by the triage reduce 3 mins from looking for ophtha ER reduce 4 mins waiting time for clerk to prepare materials reduce 40 mins waiting time for the resident to arrive

CONCLUSION reduce 5 minutes from the resident diagnosing the patient reduce 40 minutes from the patient having to provide the materials needed for emergency surgery reduce 102 minutes total = 60 minutes (1 hour)

END