PlanDoStudyAct
PDSA 3Assigning one on-call resident every day to look after triage exclusively
(23 February to 7 March 2020).
To address the problem of on-call resident being scrubbed in OT, a schedule was drawn up where one on-call resident was designated to be posted in triage alone. This change was implemented for a time period of 2 weeks.This shortened waiting time of triage patients. Change was appreciated by triage nurses as there was a fixed point of contact, but resented to some extent by on-call residents as they could not participate in OT procedures. There was an overall improvement in the process indicator up to 80% but brought forth the problems of resident dissatisfaction.This change improved triaging, hence retained. But there was need to address resident issues.
PDSA 4Dividing triage duty hours of on-call residents evenly
(8 March to 4 April 2020).
For 4 weeks, duty hours were divided such that in one duty, one resident would be responsible for OT from 14:00 to 00:00 and triage from 00:00 to 08:00; and the hours would be reversed in the next duty for the same resident.Change was well received by residents as they could perform OT procedures, as well as attend to their ward work on the side while being present in the triage area. Proportion of women correctly triaged was maintained at 80% but with overall work satisfaction among all associated personnel.Change was well received, hence retained.
PDSA 5Testing training of interns to be the first responder
(5 April to 2 May 2020).
To address the issue of manpower shortage, interns were trained to receive the triage patients, examine and colour-code them and report the findings to the resident on call. This cycle was conducted for 4 weeks.Vital signs recorded by interns were helpful but obstetric examination findings of interns could not be relied on, and the residents would often need to crosscheck those findings. Also, the labour room and triage posting of interns changed every week, and every batch needed to be trained from scratch in the application of OTAS. There was a fall in proportion of women correctly triaged to 75%.Intervention not resulting in desired outcome, hence rejecting the change. Interns were solely employed for vitals recording.