Authors (including presenting author) :
SO YT(1)
Affiliation :
(1)Department of Medicine, Queen Mary Hospital
Introduction :
In an acute general medical setting, some patients will be scheduled with a ward follow-up (WFU) appointment after discharge for tracing the results of investigations and for monitoring patient’s status during the period between hospital discharge and their subsequent SOPD or GOPD appointment. Before a WFU, medical officers and house officers will have to review patient’s medical records so as to understand their background medical condition and reasons of WFU. This process could be challenging and time-consuming as relevant medical documentation could be fragmented over the lengthy medical records. At most of the time, doctors will enquire further information from nurses so as to gather sufficient information for WFU. Besides, there are periodical changes in medical officer in- charge; during theses period, doctors might need much more time in reviewing and understanding patient’s information. This could prolong the waiting time of patients. To ensure an efficient and safe WFU workflow, enhancing communication regarding WFU is important.
Objectives :
The overall objective of this project is to enhance communication between health-care teams during WFU in an acute general medicine unit through creation of a WFU checklist. The expected outcomes of the WFU checklist are:
1) To improve efficiency of WFU through eliminating unnecessary time used for clarifying reasons and relevant information of WFU, thus to shortened the consultation time for each WFU session;
2) To improve quality of WFU by eliminating chances of overlooking reasons of WFU;
3) To improve communication and continuity of care by using a simple but clear WFU checklist (especially during periodical change in medical officers in-charge);
4) To assist ward clerk in preparing relevant information of WFU;
5) To facilitate ward clerk in storage and retrieval of medical records when consulting different medical sub-specialty teams
Methodology :
After gathering opinions from doctors, nurses and ward clerks, two simple checklists were developed. These two checklist were filled up by team nurse before patient’s hospital discharge. Ward clerks and doctors would refer to the checklists on or before the WFU appointment for preparation.
The first checklist was a simple small white WFU memo which could be affixed to patient’s medical records. It contains 1) patient’s gum label, 2) the ward unit and bed number of patients during their hospital stays, 3) a blank line for filling in the reasons of WFU, and 4) the original medical team which patients belong to. The WFU memo was renewed if a subsequent WFU was scheduled.
The second checklist was a bluish A4 consultation form which could be attached to patient’s medical records. It contains 1) the intended medical sub-specialty consultation team, 2) the reason of consultation, and 3) the date of consultation.
Result & Outcome :
Effectiveness and efficiency of the WFU communication checklist were reviewed qualitatively. Opinions from doctors, nurses, ward clerks and patients were gathered. The workflow of WFU was observed by ward clerks and APNs.
Positive results of the communication checklists were:
1) Medical officers and house officers reported less time was used in searching for reasons and relevant information of each WFU.
2) House officers and nurses reported improved efficiency of WFU (As original medical team of patient was stated in the small WFU memo, during periodical changes in medical officer in-charge, referring the case to the new respective medical officers for review and opinion became much simpler.)
3) Ward clerks reported a simpler retrieval of medical records for different medical consultation teams and easier WFU preparation.
4) Patients and their family reported acceptable waiting time of their follow-ups.
Areas of improvement were:
1) For some patients with complicated WFU reasons, nurses found that there were insufficient spaces to fill in the list of WFU reasons in the small white memo.
2) Some doctors suggested to add a section of post WFU actions in the checklist so as to enhance communication.
3) Instead of using the format of “blank line” in filling in reasons of WFU, some nurses and doctors have suggested to use a “tick format” in indicating the reasons of WFU so as to improve user-friendliness.
The development of WFU checklist has enhanced the communication of WFU information between health-care teams, which could improve the time-efficiency of WFU workflow. The chance of prolonging patient's waiting time before each consultation is also minimised. Besides, even if there is a change in doctor or nurse responsible in handling the WFU case, the WFU checklist could easily communicate patient’s condition.
In order to improve the user-friendliness of the WFU checklist, the existing checklist will be revised into a A4 size checklist using a “tick format”; a new post-WFU action session will also be incorporated. Effectiveness and efficiency of the new WFU communication checklist will be continuously reviewed.
