One of the critical factors that influence patient satisfaction in healthcare setting is the patient waiting time. Patient waiting time refers to the period it takes before a patient gets medical attention after arriving at the medical facility. Therefore, every hospital that wants to improve the satisfaction of patients must find ways of keeping the patient waiting time as low as possible. This paper proposes to reduce the patient waiting time in a primary healthcare clinic by reducing the time spent in the triage.
The paper has five sections. First, it looks at the current process in detail, with a view of justifying the choice of the triage as the place to improve patient waiting time (Mukherjee, 2006). Secondly, the paper uses Total Quality Management (TQM) principles in analyzing the problem (Mukherjee, 2006). The third area of interest is the technology that will lead to timesavings in the facility. The paper them looks at the solution in detail, then concludes by presenting a critical appraisal of the project.
Current Process Analysis
The current process used by the primary healthcare facility to provide healthcare services has three stages. These stages are registration, vital signs measurement, doctor consultation, and accessing pharmaceutical services.
The registration process usually entails three main things. First, the receptionists find out whether the patient has used the primary healthcare facility before. If yes, the receptionist retrieves the patient’s records. The receptionist then inquires on how the patient intends to pay for the service. If the patient is new to the facility, the receptionist creates a new record based on the patient’s details, and then finds out how the patient plans to pay for the service. After thus stage, the receptionist puts the patient in the queue for the next stage.
The second stage is the triage. All patients that visit the primary healthcare facility must pass through the triage. The triage nurse calls out the patients according to the order issued by the receptionist. The patient goes into the triage room and the nurse records all the vital signs and feeds these details into the electronic data retrieval system. The nurse then sends the patient to the doctor’s queue in the waiting bay.
The third stage is consultation with the resident doctor. Each patient sees one of the duty doctors for consultation. The consultation process usually results in three outcomes. First, the doctor may send the patient to the laboratory for medical tests to find out medical reasons for symptoms displayed by the patient. Secondly, the doctor may refer the patient to a specialist if the patient needs specialized attention. In the majority of cases, the doctor prescribes medication for the patient and sends the patient to the pharmacy.
The pharmacy is the final stop for the patient. The pharmacist usually checks whether the drugs prescribed by the doctor are in stock. The pharmacist may send to patient to a nurse for injection, or may give oral medication for self-administration. The patient then passes by the billing section to pay their dues if they are paying for themselves. In many cases, the primary healthcare facility records all the services rendered and bills the patient’s medical insurance provider.
Problem Analysis
The problem that needs a solution in the Primary Healthcare facility is the lengthy patient waiting time that leads to patient dissatisfaction. In the four-stage process of accessing services in the primary healthcare facility, the second stage can benefit from improvements. This stage is the vital signs measurement in the triage. The problem in this section is that the triage nurses use several types of equipment to measure vital signs.
The process takes an average of ten minutes per patient. The four main measurements they take include blood pressure, temperature, pulse rate, and respiratory rate. The solution that can help to reduce the time a patient spends in the triage is to find a way of taking all the measurements simultaneously using the same equipment. This will give concurrent readings, and will take away some time from the treatment process.
This problem exists because of the use of specialized tools to measure each vital sign. The primary healthcare facility did not change its approach to the measurement of vital signs when new equipment came to the market. The result is that the hospital keeps a large inventory of equipment used to measure different vital signs.
Technology Appraisal
Medical professionals use various tools to measure vital signs. A thermometer is the standard equipment used to measure temperate in a healthcare setting. In the past, medical professionals used thermometer placed in either the mouth or the armpits to measure body temperature.
At the time, a clinical mercury thermometer was the standard piece of equipment for the work. In recent times, infrared thermometers are becoming more popular. These thermometers take instantaneous readings based on the infrared signature of a patient’s body. They are fast. However, they may be inaccurate because they measure skin temperature, which can be higher or lower than the surrounding.
Secondly, medical professional use aneroid sphygmomanometers or electronic sphygmomanometers to measure blood pressure. Blood pressure refers to the difference between the pressure during the systolic phase and the diastolic phase of the heart.
The normal blood pressure range is somewhere between 80 (diastolic) and 120 (systolic). Patients with variances from these values can show signs of either high blood pressure (hypertension) or low blood pressure. Either of these conditions is dangerous and usually requires careful medical attention.
The measurement of the pulse rate can take place using a range of equipment. This is because the pulse is easy to feel. In fact, a doctor can measure the pulse rate of a patient using a wristwatch. The doctor counts the number of pulses felt by touching certain parts of the body per unit time. The ease of measurement of the pulse has led to the development of many types of equipment for its measurement.
The measurement of the respiratory rate is also easy. It involves counting the number of time a patient inhales or exhales per unit time (Sinreich & Marmor, 2005). In this sense, a nurse can measure a patient’s respiratory rate using any watch or timer.
In the case of the primary healthcare facility under review, the time it takes to measure these vital signs comes from the need to mount and dismount the equipment used to measure the vital signs. In addition, the nurse must take time to record each vital sign. The nurses also need time to make corrections in case of an inaccurate reading. This increases the total time needed to measure the vital signs.
Propose Solution
The proposed solution for the problem raised in the preceding sections is the use of a single equipment to measure the vital signs. The main causes of delays in the current process are as follows. First, the nurses must mount each piece of equipment on the patient. Each device needs attention to ensure that it records the vital signs correctly.
Secondly, the nurses must take the readings from each device and post them in the patient’s electronic records (Sinreich & Marmor, 2005). Thirdly, the nurse must remove dismount each equipment from the patient, and prepare them for use by the next patient. This means that the nurses repeat the process four times since each piece of equipment has its own strapping mechanism.
Equipment that measures all the vital signs at once will improve the patient waiting time in the following ways. First, the nurses will have to mount the equipment on the patient only once. This saves the time spent on mounting of equipment. Secondly, the nurse will also dismount the equipment in one move. This will reduce the time spent in dismounting the equipment.
Thirdly, the nurse will read all he measurements at once from the same screen. This will eliminate three out of four reading sessions the nurse went through initially. After releasing the patient, the nurse can attend to the next patient quicker because she will reset the equipment once. In the current case, the nurse must reset each device separately. Table 1 and table 2 below compare the benefits of this project.
Table 1: Current Process
Table 2: Proposed Process
Project Critical Appraisal
The main benefits of this project will be as follows. First, the project will reduce the overall time it takes to treat a patient by 5 minutes. This will be a 9% improvement from the current cycle. This should translate into greater patient satisfaction leading to better performance by the healthcare facility.
The second benefit is that the process will increase the productivity of the nurses working in the triage. This will result in better customer service standards. Thirdly, the accuracy of the vital signs readings will increase because the nurses will be dealing with only one piece of equipment. This will convert to better healthcare standards in the facility.
The criticisms against the project are as follows. While the project should reduce the time it takes to read the vital signs, the new equipment should not just be a collection the existing ones. Otherwise, the time it takes to mount it may remain at the current levels.
Secondly, the gains made in the triage can be lost if there are no changes in the consultation and pharmaceutical services stages. The rate of transfer of patients may simply increase from the triage queue only to decrease in the doctor’s queue. In other words, more changes are necessary in the process to ensure that the healthcare facility enjoys all the benefits of this initiative.
Conclusion
The two main lessons from this assignment are as follows. First, it is possible to improve any process by focusing on it. Secondly, gains in one process may require changes downstream and upstream to have the desired overall effect.
References
Mukherjee, P. N. (2006). Total Quality Management. New Delhi: PHI Learning Pvt. Ltd.
Sinreich, D., & Marmor, Y. (2005). Ways to Reduce Patient Turnaround Time and Improve Service Quality. Journal of Health Organization and Management, 4(2), 88-105.