QMMC- Emergency RoomOphthalmology Dept

Operations ManagementBolintiam, 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

NOProblems

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)

PROBLEMS Frequency/ days (number of times)

EFFECT TO OPERATION

Inefficient Triage System (e.g. incomplete data, wrong referrals)

1 Ophtha had to unnecessarily assess the patient again.

Patients get lost going to the ophtha ER

2 Patients get lost going to the ophtha ER Delays patient care

Lack of materials or diagnostic tools in the ER to be able to assess the condition of the patient

2 Clerk or resident has to go to the OPD to get the diagnostic tools needed while the patient waits

Magnitude-Response-Importance-Urgency (MRIU)

PROBLEMS Frequency/ days (number of times)

EFFECT TO OPERATION

Resident on duty cannot be contacted and cannot be found in his quarters

4 The clerk or intern spends time trying to call the resident in his celphone or trying to page the resident. The clerk or intern also has to roam around the hospital to look for the resident if he is not found in his quarters

Slit lamp becomes difficult to maneuver/use

4 Resident has to reset and re-adjust the slit lamp everytime it becomes defective and this causes delay in patient assessment and care

Magnitude-Response-Importance-Urgency (MRIU)

PROBLEMS Frequency/ days (number of times)

EFFECT TO OPERATION

No available sutures/gloves/gauzes to be used for managing trauma cases

4 Patient or relatives have to buy materials before the patient is managed. The resident cannot do anything to manage the patient without materials for suturing

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 planninga. Purchase special equipment that will be for ER

use onlyb. Provide more chairs, stretchers, and beds for

the patientc. Purchase medical supplies for the ERd. Duty phone and extra beds for residents-on-

dutye. 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 planninga. Duty phone and extra beds for residents-on-

dutyb. 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 • 162-102= 60 minutes (1 hour)

Thank youEND