qmmc- emergency room ophthalmology dept

QMMC- Emergency RoomOphthalmology Dept

Operations ManagementBolintiam, Cruz, Rivera, Valera

July 04, 2011

The QMMC Ophtha ER• Opens after Ophtha OPD

hours (5 PM- 8 AM the following day) 

• Manned by an intern and the Resident-on-Duty

• Provides emergency medical and surgical Ophtha care

• Would attend to patients with complaints in the ff areas (upper half of the face)

    - Eye    - Eyebrow    - Lower lid 

Current Operations Flowchart

THE PROBLEMS

•Confusing wrong referrals

• Incomplete charts

INEFFICIENT TRIAGE SYSTEM

•The way to the ophtha ER is very confusing and the patients could easily get lost leading to slower care for patients

LACK OF DIRECTIONAL CUES

•OPD and Resident’s quarters is far from the ER

•Resident’s delayed response to referrals

SLOW PATIENT RESPONSE

•Limited space (shared with ENT dept)

•Only one bed (shared with ENT)

NOT ENOUGH ROOM FOR PATIENTS

•No readily available supplies

•Patient has to buy the supplies first before they can be treated.

LACK OF SUPPLIES

•No Snellen Chart▫should be taken

from the TR first▫Not standardized

•Defective Slit Lamp

SUBSTANDARD OR LACKING MEDICAL EQUIPMENT

•Other materials needed for the diagnostics are in the OPD (tonometer, special lenses, surgical materials)

SUBSTANDARD OR LACKING MEDICAL EQUIPMENT

•Conflicts with other departments

•Patients are not attended immediately by residents of other departments

POOR INTER-DEPARTMENTAL REFERRAL

•departments in the ER are far from the ophtha ER room

POOR INTER-DEPARTMENTAL REFERRAL

PROPOSED SOLUTIONS

Proposed Flow Chart

Problem 1: Inefficient Triage System

• Clearer guidelines should be made regarding referral of patients

• Initial history and PE should be done in the triage. Vital signs and pertinent history

• Priority given to emergency and urgent cases.• Patients with non-urgent cases can be

attended only after all emergency and non-urgent cases are managed.

Problem 2: Lack of directional cues

• Sign outside the opthalmology ER • Signs that will lead to other departments

Problem 3: Slow patient response• Interns and Residents are expected to be in the

ER most of the time. In special cases, residents are required to be

in the ER within 15 minutes after the referral. • Stricter rules regarding interns and residents

who are out-of-posts.• Penalties/Incidental Reports

Problem 4: Not enough room for patients• Extra beds and stretchers• Coordinate with the ENT resident

If ENT and Ophtha both have urgent surgical cases at the same time, they can coordinate with the Surgery ER to use their beds

• One watcher per patient as much as possible.

Problem 5: Lack of supplies

• Commonly used supplies should be readily available (gloves, sutures, micropore medical tape, etc.)o can be replaced by the patient after or can

be given free to patients who could not really afford

Problem 6: Substandard Medical Equipment Special Equipment that will be for ER use only Install a permanent Snellen chart in ER

• can be calibrated to 20 feet. Repair slit lamp or purchase a new one. Alternative: Use equipment in the OPD for the

meantime. Transfer to the ER when the OPD closes.

Problem 7: Poor interdepartmental referrals• Referral slips

• Should be signed by the resident before they refer the patient back to the referring department

• Inter-departmental Feedback

Thank youEND