Qmmc emergency room ophthalmology dept
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QMMC- Emergency Room Ophthalmology Dept. Operations Management Bolintiam, 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

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QMMC- Emergency Room Ophthalmology Dept

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Qmmc emergency room ophthalmology dept

QMMC- Emergency RoomOphthalmology Dept

Operations Management

Bolintiam, Cruz, Rivera, Valera

July 04, 2011


The qmmc ophtha er

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 Ophthacare

  • Would attend to patients with complaints in the ff areas (upper half of the face)

        - Eye

        - Eyebrow

        - Lower lid 


Current process flowchart

CURRENT PROCESS FLOWCHART


Qmmc emergency room ophthalmology dept

Initial Assessment at the triage

Problems on the upper half of the face (eye, eyebrow, lower lid

NO

Refer to other departments

YES

REFER TO OPTHA


Qmmc emergency room ophthalmology dept

Refer to Optha

Initial Assessment by the Intern

Patient referred to resident

Secondary Assessment of the resident


Qmmc emergency room ophthalmology dept

Secondary Assessment of the resident

Resident manages the case

Other problem?

NO

YES

Refer to other departments

Patient Discharged


The problems

THE PROBLEMS


Magnitude response importance urgency mriu

Magnitude-Response-Importance-Urgency (MRIU)


Magnitude response importance urgency mriu1

Magnitude-Response-Importance-Urgency (MRIU)


Magnitude response importance urgency mriu2

Magnitude-Response-Importance-Urgency (MRIU)


Objective

OBJECTIVE


Objective1

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

SOLUTIONS


Process improvement flowchart

Process Improvement flowchart


Final recommendations

FINAL RECOMMENDATIONS

  • Intermediate range planning

  • Purchase special equipment that will be for ER use only

  •  Provide more chairs, stretchers, and beds for the patient

  • Purchase medical supplies for the ER

  • Duty phone and extra beds for residents-on-duty

  • Create Clinical Pathways to guide those who are in charge of the triage for appropriate referral

  • Add manpower in the triage area


Final recommendations1

FINAL RECOMMENDATIONS

  • Intermediate range planning

  • Duty phone and extra beds for residents-on-duty

  • Create Clinical Pathways to guide those who are in charge of the triage for appropriate referral

  • Add manpower in the triage area


Final recommendations2

FINAL RECOMMENDATIONS

  • Short range planning

  • 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 recommendations3

FINAL RECOMMENDATIONS

  • Short range planning

  • 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.

  • Put up Signs that will lead patients going to ophthaER and to other departments


Conclusion

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


Conclusion1

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 you

Thank you

END


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