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

2. 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

3. Current Operations Flowchart

4. THE PROBLEMS

5. Confusing  wrong referrals Incomplete charts INEFFICIENT TRIAGE SYSTEM

6. The way to the ophtha ER is very confusing and the patients could easily get lost leading to slower care for patients LACK OF DIRECTIONAL CUES

7. OPD and Resident’s quarters is far from the ER Resident’s delayed response to referrals SLOW PATIENT RESPONSE

8. Limited space (shared with ENT dept) Only one bed (shared with ENT) NOT ENOUGH ROOM FOR PATIENTS

9. No readily available supplies Patient has to buy the supplies first before they can be treated. LACK OF SUPPLIES

10. No Snellen Chart ▫ should be taken from the TR first ▫ Not standardized Defective Slit Lamp SUBSTANDARD OR LACKING MEDICAL EQUIPMENT

11. Other materials needed for the diagnostics are in the OPD (tonometer, special lenses, surgical materials) SUBSTANDARD OR LACKING MEDICAL EQUIPMENT

12. Conflicts with other departments Patients are not attended immediately by residents of other departments POOR INTER- DEPARTMENTAL REFERRAL

13. departments in the ER are far from the ophtha ER room POOR INTER- DEPARTMENTAL REFERRAL

14. PROPOSED SOLUTIONS

15. Proposed Flow Chart

16. Problem 1: Inefficient Triage System Clearer guidelines should be made regarding referral of patients 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.

17. Problem 2: Lack of directional cues Sign outside the opthalmology ER Signs that will lead to other departments

18. Problem 3: Slow patient response Interns and 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 interns and residents who are out-of-posts. Penalties/Incidental Reports

19. Problem 4: Not enough room for patients Extra beds and stretchers Coordinate with the ENT resident  If ENT and Ophtha both have urgent surgical cases at the same time, they can coordinate with the Surgery ER to use their beds One watcher per patient as much as possible.

20. Problem 5: Lack of supplies Commonly used supplies should be readily available (gloves, sutures, micropore medical tape, etc.) o can be replaced by the patient after or can be given free to patients who could not really afford

21. Problem 6: Substandard Medical Equipment  Special Equipment that will be for ER use only  Install a permanent Snellen chart in ER can be calibrated to 20 feet.  Repair slit lamp or purchase a new one.  Alternative: Use equipment in the OPD for the meantime. Transfer to the ER when the OPD closes.

22. Problem 7: Poor interdepartmental referrals Referral slips Should be signed by the resident before they refer the patient back to the referring department Inter-departmental Feedback

23. END