Background The paediatric ambulatory care department has multiple functions such as administration of IV antibiotics, blood transfusions, urgent outpatient blood tests and clinical reviews. The patients coming into the paediatric ambulatory care unit were organised in a physical handwritten diary with MDT members manually writing down who was supposed to come into the unit.
This led to many issues:
There was no specific follow up system for these patients. Certain blood tests take 24 hours or longer to come back and when these were missed serious incidents occurred.
Patients would often be double booked to see the same doctor
Often the unit had too many patients in it for a single day leading to long waits and lower patient satisfaction
Patient identifiable information was often illegible in the book making it difficult to understand who was coming into the unit
There wasn’t any space in the book for writing the reasons a patient was coming in. This often led to confusion
We created a computerised system in order to deal with these problems.
Objectives The objectives of this project were:
To increase the amount and clarity of patient identifiable details
To ensure the reason for the appointments was clearer
To reduce the number of double bookings
To reduce the number of serious incidents from patients not being followed up correctly.
Methods The multidisciplinary team involved in the project entirely upheaved the appointment system and created a computerised appointments book using excel. We used various techniques to help reduce the number of errors in the input of data. For example, error messages would appear if appointments were double booked. We also had a built-in follow up system. This would highlight patients whose results hadn’t been followed up which would also help prevent mistakes. This QI project had 5 cycles in which the system was fine-tuned, tutorials were given to members of the MDT and feedback was taken. This helped us promote a sustainable change and allowed us to troubleshoot any issues with the appointment system. After each cycle our objectives were measured quantitatively.
We found that the number of patients with three pieces of patient identifiable data increased by 56% (patients with at least 2 pieces of identifiable details also increased).
The number of patients with clear reasons inputted for coming to the paediatric ambulatory care unit increased by 22%.
The number of double bookings decreased by 20%.
The number of patients who weren’t followed up were also reduced (results went down from 4 serious incident form in the 6 month period before the computerised system to no serious incident forms in the 6 months after the system.
Conclusions This QI project showed that simple IT solutions can often lead to dramatic improvements in patient safety and better care. The reduction of human error is important for any paediatric department. Involving the multidisciplinary team in projects can lead to a more sustainable change and is necessary when creating changes to systems.
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