Authors (including presenting author) :
Fung YSE (1), Chan PSC (2), Chan TMA (2), Cheng CKJ (2), Lee WKS (2), Pang WMA (2), Wong SMR (2), Wong YPJ (2)
Affiliation :
(1) CQI project Leader, Q&S subcommittee of OTCOC, Hospital Authority (2) CQI project Committee Member, Q&S subcommittee of OTCOC, Hospital Authority
Introduction :
The implementation of an effective outpatient triage system is a cornerstone in optimizing the operations of Occupational Therapy (OT) Departments. By conducting a comprehensive audit on the triage of new out-patient cases, the project aimed to standardize procedures across departments, thereby reducing workflow discrepancies and enhancing operational precision. This project was an intra-cluster, cross-hospital exercise, leveraging the expertise of seasoned professionals from each cluster to scrutinize current practices and introduce an improved audit tool for cluster-wide application. This CQI project fell under the purview of the Q&S subcommittee of the OTCOC HA.
Objectives :
This is the first OT audit focused on outpatient new case triage, with the following objectives: 1.To raise awareness of the systematic OT outpatient new case triage workflow across all OT departments. 2.To support OT departments in improving operational systems by establishing appropriate workflows for outpatient triage and appointment processes, aligned with the HA SOPC operation manual recommendations. 3.To design an outpatient new case triage audit format and process for departmental implementation. 4.To evaluate the accuracy of the triage process.
Methodology :
The audit was conducted as an on-site exercise across all OT departments managing outpatient cases. Auditors from various hospitals within the same cluster utilized a mutually agreed-upon audit form, referencing triage criteria for OT outpatient services as defined by OTCOC, to evaluate the triage process. The audit was completed by mid-Jan 2024. A random sampling strategy was employed, targeting approximately 3% of new cases registered from November to early December 2023, ensuring a minimum of 30 calendar days for data collection. The audit roadmap included forming a task group to establish best practices for outpatient new case triage workflows, developing an audit format and logistics, conducting preparatory briefings for departments and auditors, and performing a retrospective review of departmental triage systems for accuracy. This structured approach emphasized the commitment to improving service quality and operational efficiency within OT departments.
Result & Outcome :
The on-site audit was conducted from Dec 2023 to Jan 2024, utilizing on-site, retrospective, and random sampling methods carried out by cross-hospital auditors. A total of 34 centers, including 24 general centers and 11 psychiatric centers (one of which combined gen. and psy. services), participated in the audit. All OT departments managing outpatient cases were involved. Regarding workflow adoption, 4 centers exclusively used workflow A, 7 centers exclusively used workflow B, and 23 centers adopted both workflows A and B. All 34 centers were prepared for the audit exercise. During the 30-day period from November to early December 2023, 11,407 cases met the criteria for the audit, of which 459 cases (4%) were audited. The specialty distribution of audited cases was as follows: 108 cases (23.5%) in M&G, 217 cases (47.2%) in O&T, 104 cases (22.7%) in Psychiatry, and 30 cases (6.5%) in other specialties, such as A&E. The triage category distribution included 80 cases (17.4%) in Priority 1 (P1), 210 cases (45.8%) in Priority 2 (P2), and 169 cases (36.8%) in Routine (R). The audit achieved an accuracy and compliance rate of 99.6%, with only 2 out of 459 cases not meeting 2 specific criteria. The instances of non-compliance were related to triage records (e.g., missing staff names, ranks, and signatures) and did not impact the triage process itself. Feedback and recommendations from the auditors were provided to the centers and consolidated for review by the project committee. Conclusion: 1.The OT outpatient triage system and workflow were improved. 2.A new audit format and process were developed.3.The successful audit outcome indicates that the existing practices closely adhere to the established criteria. 4.Good practices were shared across all clusters.
