1. Background and Aim Improved CT scan workflow between Department of Emergency Medicine (DEM) and Emergency Imaging Centre (EIC), SGH Mr Heng Yi Xiong 1 , Dr Sohil Pothiawala 2 , Ms Toh Hong Guan 3 , Ms Florence Wong 4 , A/Prof Agnes Tan 1 1 : Division of Ambulatory & Clinical Support Services, 2 : Dept of Emergency Medicine, 3 : Dept of Diagnostic Radiology, 4 : Clinical Governance 2. Methodology 3. Results 4. Conclusion Since 2013, there were a number of CT scan incidents reported by DEM and EIC. Findings from root cause analysis sessions attributed both human and system factors as root causes. A multi disciplinary team was formed to review the CT scan workflow to reduce the turnaround times and occurrences of CT scan errors, and improve communication between the staff of DEM and EIC. The improvisations in the CT scan workflow achieved improved turnaround times for critical CT scans in DEM, prevented occurrences of CT scan errors, achieved better utilisation of manpower resources and improved communications between DEM and EIC staff. •DEM/EIC staff and DEM patients were shadowed and interviewed for their experience during a CT scan procedure. •Observations were grouped together to identify insights themes & opportunity areas. •Rationales of the various processes and past experiences were also shared and discussed. •Examining the opportunity areas, the members brainstormed and suggested workflow improvements. •A vote was held to decide which ideas to implement. •The ideas were mapped out into a solution tree (right). •The ideas were also categorised for immediate, mid-term and future implementation, aligning them to the hospital’s policies and future goals. Improved workflow Improved turnaround time Improved Safety 6 Checkpoints 6 Staff The workflow is streamlined to involve only 6 staff and 6 points of verification, compared to the previous 7 staff and 11 points of verifications. Special thanks to sponsors and colleagues from Division ACSS, DEM, Dept of Diagnostic Radiology, Nursing, Clinical Governance and Service Operations for their assistance and support in the project. The median turnaround time for a CT scan for critical care (P2) patients was reduced from 53 to 43 minutes. No incidents of CT scan error reported in DEM since the implementation of the new workflow on 9 Feb 2015, which is the longest period so far. Understand Explore Test Immediate Mid-term Future Implement How do we redesign CT scan workflow to eliminate errors? How could we ensure that doctors, nurses and radiographers are updated of all CT scan orders/ cancellations? How could we prevent doctors from toggling between 2 systems? How could we ensure doctors comply to a standardised ordering workflow, yet allow for flexibility in ordering? How could we ensure that staff can locate patients quickly and effectively? How could we ensure that the trolley number is always reflected on CT request form? How could we reduce redundant steps/handovers? Tracking board in new SCM ED module with live updates via icons for radiology orders. Educate & reinforce implications of ordering CT scan without prior approval by senior doctors. Explore RFID tag on wrist tag/trolley. Explore adding a field for trolley number in CPOE form for CT scans. Adopt a pull system by having radiographers fetch DEM patients for CT scans. (9 Feb 2015) Single reference point to check patient identifiers (check CPOE order form and not case folder). Explore auto-printing of CPOE form direct to EIC to eliminate manual transportation of form. Immediate () Future Immediate () Immediate () Future Mid-term () Mid-term Implementation Solutions Opportunity areas Problem Solution tree
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1. Background and Aim
Improved CT scan workflow between Department of Emergency Medicine (DEM) and
Emergency Imaging Centre (EIC), SGH Mr Heng Yi Xiong1, Dr Sohil Pothiawala2, Ms Toh Hong Guan3,
Ms Florence Wong4, A/Prof Agnes Tan1
1: Division of Ambulatory & Clinical Support Services, 2: Dept of Emergency Medicine, 3: Dept of Diagnostic Radiology, 4: Clinical Governance
2. Methodology
3. Results
4. Conclusion
Since 2013, there were a number of CT scan incidents reported by DEM and EIC. Findings from root cause analysis sessions attributed both human and system factors as root causes. A multi disciplinary team was formed to review the CT scan workflow to reduce the turnaround times and occurrences of CT scan errors, and improve communication between the staff of DEM and EIC.
The improvisations in the CT scan workflow achieved improved turnaround times for critical CT scans in DEM, prevented occurrences of CT scan errors, achieved better utilisation of manpower resources and improved communications between DEM and EIC staff.
•DEM/EIC staff and DEM patients were shadowed and interviewed for their experience during a CT scan procedure.
•Observations were grouped together to identify insights themes & opportunity areas.
•Rationales of the various processes and past experiences were also shared and discussed.
•Examining the opportunity areas, the members brainstormed and suggested workflow improvements.
•A vote was held to decide which ideas to implement.
•The ideas were mapped out into a solution tree (right).
•The ideas were also categorised for immediate, mid-term and future implementation, aligning them to the hospital’s policies and future goals.
Improved workflow Improved turnaround time Improved Safety
6 Checkpoints 6 Staff
The workflow is streamlined to involve only 6 staff and 6 points of verification, compared to the previous 7 staff and 11 points of verifications.
Special thanks to sponsors and colleagues from Division ACSS, DEM, Dept of Diagnostic Radiology, Nursing, Clinical Governance and Service Operations for their assistance and support in the project.
The median turnaround time for a CT scan for critical care (P2) patients was reduced from 53 to 43 minutes.
No incidents of CT scan error reported in DEM since the implementation of the new workflow on 9 Feb 2015, which is the longest period so far.
Understand Explore Test
Immediate
Mid-term
Future
Implement
How
do
we
rede
sign
CT
scan
w
orkf
low
to e
limin
ate
erro
rs?
How could we ensure that doctors, nurses and radiographers are updated of all CT scan orders/ cancellations?
How could we prevent doctors from toggling between 2 systems?
How could we ensure doctors comply to a standardised ordering workflow, yet allow for flexibility in ordering?
How could we ensure that staff can locate patients quickly and effectively?
How could we ensure that the trolley number is always reflected on CT request form?
How could we reduce redundant steps/handovers?
Tracking board in new SCM ED module with live updates via icons for radiology orders.
Educate & reinforce implications of ordering CT scan without prior approval by senior doctors.
Explore RFID tag on wrist tag/trolley.
Explore adding a field for trolley number in CPOE form for CT scans.
Adopt a pull system by having radiographers fetch DEM patients for CT scans. (9 Feb 2015)
Single reference point to check patient identifiers (check CPOE order form and not case folder).
Explore auto-printing of CPOE form direct to EIC to eliminate manual transportation of form.
Immediate ()
Future
Immediate ()
Immediate ()
Future
Mid-term ()
Mid-term
Implementation Solutions Opportunity areas Problem
Solution tree
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