The Osteoporosis Refracture Prevention (ORP) service, located within Royal Prince Alfred Hospital (RPA), has recently experienced multiple instances of patients missed or lost to follow-up, in addition to staff indicating frustration with their workflows.
The clinic, which is staffed by two consultants and a transient trainee specialist, has an average attendance of seven patients per week, with 33% of appointments made in the clinic resulting in a no-show or cancellation, leading to several empty slots within the schedule. The service is also struggling to capture the number of patients it should; currently, the service only identifies 35% of minimal trauma fractures that present to RPA, with 27% of patients failing to return for their review appointments in the ORP clinic. Moreover, the current wait time for patients returning for a review appointment is ten months. These factors increase the risk of patients re-fracturing and not receiving the appropriate care.
This project aims to improve patient access to care and increase the efficiency of staff workflows and processes within the ORP service. To achieve this aim, the project team has reevaluated the processes used to triage patient referrals, schedule appointment times and review patients in future appointments. As a result of staff interviews and a brainstorming workshop with key process owners, several solutions were identified, with the project’s steering committee asked to rate the ability to influence and impact each solution based on a standardised rubric. The ratings were evaluated, and the solutions prioritised were exploring clearer communication with patients, holding regular patient triage meetings, and revising clinic documentation.
Strategies were developed to improve communication with patients about their appointments regarding booking processes, reminders for patients and checklists for staff. The documentation of clinical details has also been re-evaluated to relieve nurses from transcribing consult details onto eMR. Clinicians will instead document a clinical progress note into eMR which will be printed and given to the patient. This will act as a written outcome of their appointment and action plan for their care. Meetings are being held to discuss patients and referrals to be triaged, and strategies are being developed to triage referrals more effectively.
View this project's poster from the Centre for Healthcare Redesign graduation May 2024.
