Workflow & Team Structure Revamp in Emergency Department to Shorten the Patients Waiting Time Dr. FT Lee Accident & Emergency Department Princess Margaret Hospital
Background A&E Triage System in HK Cat I Critical Cat II Emergency Cat III Urgent Cat IV Semi-urgent Cat V Non Urgent Pledge Target Cat II Cat III Cat IV 95% within 15 mins 90% within 30 mins 75% within 120mins
Our Performance 2005 2006 2007 2008 2009 2010 Cat II 94% 93% 93% 95% 96% 97% Cat III 81% 80% 70% 74% 88% 91% Cat IV 73% 64% 51% 64% 68% 67% Pledge Target Cat II Cat III Cat IV 95% within 15 mins 90% within 30 mins 75% within 120mins
The Impact
Revamp at Feb, 2011 3 Steps Revamp of Workflow Fast Track System Revamp of Team Structure
Our Performance since February 2011 100% % of Cat IV patients seen within 120min % of Cat III patients seen within 30 mins 95% 90% 85% 80% 75% 70% 65% Revamp started 60% Nov- 10 Dec- 10 Jan- 11 Feb- 11 Mar- 11 Apr- 11 May- 11 Jun- 11 Jul- 11 Aug- 11 Sep- 11 Oct- 11 Nov- 11 Dec- 11 Jan- 12
Statistical Analysis Triage Category Before revamp Feb 10 to Jan 11 After revamp Feb 11 to Jan 12 Improvement p value II 96% 97% 1% 0.1 III 91% 94% 3% <0.01 IV 67% 83% 16% <0.01 The median end waiting time for Cat IV patients was shortened from 84 mins to 55 mins (p < 0.01)
Daily Attendance 2010 (Feb) to 2011 (Jan) 2011 (Feb) to 2012 (Jan) Average Daily Attendance 382 (SD 13.5) 389 (SD 6.4) Standardized Admission Rate (Feb 11 Jan 12) PMH KWC HA overall 25.1% 26.1% 26.3%
Step 1: Revamp of Workflow There is No Waste in Nature That s Human who creates Waste Eliminate Waste in our Work Flow to Improve our Efficiency and Effectiveness
Spaghetti Diagram before Revamp Motion Waste Patients Flow Doctors Flow Records Flow......
Turn a Consultation Room into Waiting Room
Usher brings Patients to Designated Waiting Area Spaghetti Diagram after revamp & Records to & from the doctors 1. Elimination of Motion Waste of Doctors 2. Shorten the time waiting for patient Patients Flow Doctors Flow Records Flow......
Step 2: Fast Track System
Fast Track System of Minor Injury cases Ethically and Clinically indicated Reduce Pain Reduce Bleeding Reduce Wound Infection Early management of Fracture, Dislocation & Soft Tissue injury
Frequency Waiting Time of Cat IV Minor Injury Cases 9 8 7 6 5 4 3 2 1 0 Before Histogram < 90 91-120 121-150151-180181-210211-240 > 240 Interval (In Minute) After Only 7% have waiting time within 120 minutes. Most (57%) have waiting time between 181-210 minutes. ALL minor injury patients have waiting time within 120 minutes. The Mean Waiting Time shortened from 194 minutes to 24 minutes. 76% of minor injury patients have waiting time within 30 minutes
Step 3: Revamp of Team Structure
A Project can Never be Perfect but a TEAM can
Team Structure Revamp Departmental Management Committee Key Performance Indicator (KPI) Team Quality & Safety Team Training & Development Team
Team Structure of PMH (A&E) DMC Chairman: Dr Albert Lit (COS) Co- chairman: Dr LH Chiu /Dr FT Lee / Mr. TK Tang Secretary: Tracy Chan Members: Mr.. Norman Chik, Dr YN Shih, Dr CM Chan Dr CS Leung, Dr Clarence Chu Ms SY Leung, Ms YM Tang, Ms Vivien Ho Ms Sheila Wong, Ms Eva Tsang, Mr. WK Chan Training & Development Team Chairman: Dr CM Chan Co Chairman:Dr TL Hui/Dr YK Li / Ms SK Cheng Members: Dr FT Lee, Dr William Wong, Mr.. KY Lam, Mr.. T W Wong, Mr.. M Leung, Mr.. Godfrey Wong, Mr.. WK Chan, Ms. Mimi So Quality & Safety Team Chairman:Dr FT Lee Co-Chairman:Dr HK Ngan / Mr. KT Tang Members: Dr CS Leung, Dr Christine Chung, Dr LW Cheung Ms Vivien Ho, Ms. Susan Kwan Ms. S Y Leung, Mr.. MF Lai, Ms. Selina Chau, Ms. Sheila Wong KPI Team Chairman: Dr Shih YN (SMO) Cochairman: Dr Hui TL (SMO) Dr Mo KK (RS) Key Performance Indicators Team Mr Norman Chik (WM) Chairman: Dr YN Shih Co Chairman: Dr TL Hui/Dr KK Mo/ Mr.. Norman Chik Members: Members: Dr. Clarence Chu, Dr Ivan Lai Ms. K L Li, Ms. YM Tang, Ms. T W Lui, Ms. Fisa Wong
Leadership Authoritative Delegative Participative
Team Structure Revamp Engagement >50% Medical Staff ~ 25% Nursing staff Ownership Communication Opinions are Listened Trust & Respect Awareness
Posting of the daily waiting time performance at the eye-catching area to increase Staff s Awareness
The Beginning of the End "Success is not final, failure is not fatal; it is the Courage to Continue that counts" Winston Churchill
Challenges Ahead Surge in attendance Manpower Shortage Ageing population High public expectation Inflation Others.
Dr. Nancy SY Tung, Dr. Albert CH Lit, Mr. Philip PW Choi Dr. Lee Fu Tat Dr. Shih Yau Ngai Dr. Ngan Hung Kwok Mr. Tang Kam Tim Ms. Leung Sin Yee Dr. William CL Wong Dr. KK Mo CCE (KWC) COS (A&E, PMH & YCH) GMN (KWC) Con (A&E, PMH) Con (A&E, PMH) SMO (A&E, PMH) WM (A&E, PMH) NO (A&E, PMH) RS (A&E, PMH) RS (A&E, PMH) And Most of All Our Colleagues whom are now working hard in A&E department