PT  - JOURNAL ARTICLE
AU  - Emily Tse Lin Ho
TI  - Improving waiting time and operational clinic flow in a tertiary diabetes center
AID  - 10.1136/bmjquality.u201918.w1006
DP  - 2014 Jan 01
TA  - BMJ Quality Improvement Reports
PG  - u201918.w1006
VI  - 2
IP  - 2
4099  - http://bmjopenquality.bmj.com/content/2/2/u201918.w1006.short
4100  - http://bmjopenquality.bmj.com/content/2/2/u201918.w1006.full
SO  - BMJ Qual Improv Report2014 Jan 01; 2
AB  - The Singapore General Hospital Diabetes Centre (DBC) is a multidisciplinary specialist outpatient clinic which aims to provide an integrated one-stop service for diabetes. As with many tertiary academic centre clinics, DBC encounters an expanding patient load, greater patient expectations and increasingly complicated patients who require services from a multitude of health providers. Such rising demands amidst limited resources cause inefficiencies and long waiting times to consultation. This result in low patient satisfaction and an unpleasant clinic experience. A multidisciplinary team was formed to reduce the waiting time at DBC and improve communication and work processes of staff. Addressing wait-times is complicated as multiple stakeholders and operational processes are involved and interlinked. By systematically breaking down processes and identifying problem areas, targeted changes were implemented. This included a revised model of appointment scheduling, a patient reminder system, more effective communication sheets and work reassignments. The primary aim of this project was to improve the patient turn-around time (duration a patient spends at the centre for a visit). There was no documented improvement in turn-around time after project implementation ( 108.23 minutes versus 106.6 minutes) but other secondary aims were achieved. These included an increase in the percentage of patients seen by the doctor within 60 minutes from 80% to 84%, a reduction in wait-time for payment and reappointment at the cashier by 36.6% and a reduction in non-attendances of new cases to the clinic from 30.2% to 21.3%. Staff satisfaction and communication were greatly improved. To aid sustainability, personalized reports of individual doctor’s waiting times and workload were produced quarterly and tracked. As this is a first step quality improvement project, efforts to track, examine and further improve turn-around times are on-going. Future initiatives are directed at time-efficient appointment scheduling between care providers for same day appointments, a reactive SMS system for reminders and reappointments and optimization of processes and manpower allocation for clinics.