Small changes, big results


EARLY TREATMENT, EARLY RECOVERY: With a few tweaks to the existing system, heart patients can now be admitted faster.

IT USED to take an average of about four hours for cardiac patients to go from the Department of Emergency Medicine (DEM) to the wards. Now it takes less than three – which is significant time saved.

A seven-member team of nurses at the National Heart Centre of Singapore (NHCS) managed to cut the waiting time after studying the admission process and instituting small but significant changes.

Ms Yip Yeok Mui, Nurse Clinician, Ward 44, NHCS, who was the team leader, said that on average, 23 per cent of patients wait more than four hours to be admitted to the wards. “Our goal is to allow heart patients to receive specialist care as soon as possible, because early treatment will lead to early recovery,” she said.

One reason was the delay in acknowledging when a bed was ready. Previously, when a patient needed to be admitted to a ward, DEM staff would alert the wards through the Bed Management System (BMS) at the nurses’ station. When the alert was acknowledged, it meant a bed would be reserved for the patient and DEM staff could then send him to the ward once the bed was ready. But when nurses were busy or away from the station, acknowledgement of the alert would be delayed, causing DEM staff to assume that no beds were available and leaving the patient to wait.

The solution

To stop the delay, nurses agreed to acknowledge all alerts within 10 minutes. After implementing this, they managed to acknowledge 86 per cent of the alerts within 10 minutes and almost 100 per cent within an hour.

Further improvements were made to solve the problem of new patients having to wait for those being discharged, as the checkout time coincided with the housekeeping staff’s breaks. To address this, the staff were asked if they could shift their breaks to an hour earlier, so they could prepare the beds for new patients.

A system was also set up where patients could check out early and wait in transit lounges for their families.

Meanwhile, doctors helped by informing staff of patients who might be discharged the following day. This allowed staff to alert the families, so they could make arrangements to fetch the patients early.

“As a result, more beds were made available earlier for patients who needed to be admitted urgently,” said Ms Yip.

The changes did not just benefit cardiac patients at DEM, 90 per cent of whom were admitted in less than three hours. They also reduced the stress and agitation of family members, resulting in fewer incidents of patients and families venting their frustration on nurses. In addition, there was reduced congestion at DEM, allowing staff to devote their resources to other patients.

“This initiative has shown positive results and can be rolled out to other hospitals. However, we are still tracking it as it is still very new. But we feel satisfied and happy that we were able to do something to improve the experience for our patients and staff,” said Ms Yip.

This story was first published in Singapore Health, Jan/Feb 2012.