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 95% within 15 mins Cat III 90% within 30 mins Cat IV 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 95% within 15 mins Cat III 90% within 30 mins Cat IV 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

60%

65%

70%

75%

80%

85%

90%

95%

100%

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

% of Cat IV patients seen within 120min % of Cat III patients seen within 30 mins

Revamp started

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

• Standardized Admission Rate (Feb 11 – Jan 12)

2010 (Feb) to 2011 (Jan) 2011 (Feb) to 2012 (Jan)

Average Daily Attendance 382 (SD 13.5) 389 (SD 6.4)

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

Spaghetti Diagram after revamp

Usher brings Patients

to

Designated Waiting Area

&

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

Waiting Time of Cat IV Minor Injury Cases

0

1

2

3

4

5

6

7

8

9

< 90 91-120 121-150 151-180 181-210 211-240 > 240

Fre

qu

en

cy

Interval (In Minute)

Histogram

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

Before After

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

Key Performance Indicators

Team

Chairman: Dr YN Shih

Co Chairman: Dr TL Hui/Dr KK Mo/ Mr.. Norman Chik

Members:

Dr. Clarence Chu, Dr Ivan Lai

Ms. K L Li, Ms. YM Tang,

Ms. T W Lui, Ms. Fisa Wong

KPI Team

Chairman: Dr Shih YN (SMO)

Cochairman:

Dr Hui TL (SMO)

Dr Mo KK (RS)

Mr Norman Chik (WM)

Members:

Authoritative

Delegative

Participative

Leadership

• Engagement

>50% Medical Staff

~ 25% Nursing staff

• Ownership

• Communication

Opinions are Listened

Trust & Respect

• Awareness

Team Structure Revamp

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, CCE (KWC) Dr. Albert CH Lit, COS (A&E, PMH & YCH) Mr. Philip PW Choi GMN (KWC) Dr. Lee Fu Tat Con (A&E, PMH) Dr. Shih Yau Ngai Con (A&E, PMH) Dr. Ngan Hung Kwok SMO (A&E, PMH) Mr. Tang Kam Tim WM (A&E, PMH) Ms. Leung Sin Yee NO (A&E, PMH) Dr. William CL Wong RS (A&E, PMH) Dr. KK Mo RS (A&E, PMH)

And Most of All

Our Colleagues whom are now working hard in A&E department