Streamlined Intratympanic Steroid Injection Procedure in YCH Outpatient Clinic

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Abstract Summary
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Authors (including presenting author) :
Pang YL(1), Ngai CM(2), Tsang WY(1), Wong KC(2), Yau CL(1), Yau YK(1)
Affiliation :
(1) Outpatient Department, Yan Chai Hospital, (2) ORL-HNC Department, Yan Chai Hospital
Introduction :
Timely management of patients suffering from sudden sensorineural hearing loss by Intratympanic Steroid injection (ITS) is essential. Previously, this procedure was provided in ward setting as day-case which are costly and time-consuming. However, it would increase the workload of the ward especially during winter surge. In view of service demands, Yan Chai Hospital started to provide ITS service in the outpatient clinic since July 2018 and most of the patients no longer require hospitalisation for the procedure.
Objectives :
To provide prompt, timely and quality outpatient ITS treatment to shorten patients’ total treatment time through process re-engineering, and to reduce hospital stay so as to alleviate ward’s overcrowding condition, and thus increase patients’ overall satisfaction.
Methodology :
A questionnaire was designed for patients to evaluate their satisfaction and another questionnaire together with nursing audit for staff to evaluate their knowledge and abilities, and the qualities of the outpatient ITS.
Result & Outcome :
A total of 23 patients participated the survey with response rate 100%. Only one patient terminated the treatment due to personal reason. All respondents were satisfied with the service. Moreover, evaluation results showed all staff in our unit were familiar with the contents in the training lesson and could apply the knowledge and skill on daily works. The success of the program was attributed to patients’ and staff’s positive attitude and it helps to reduce day admission workload in ENT ward. Besides, nursing audits were performed to ensure acceptable efficiency, standardized outcome measures and quality of care. From July 2017 to February 2018, 95 ITS were undergone in ward, which was greatly reduced to 14 cases within similar 8 months in 2018/2019, after the introduction of outpatient ITS service. The ward manpower therefore was released. Besides, the average total waiting time from registration, Shroff, procedure, completion of treatment to patient leaving OPD was shortened by 6 hours 33 minutes when compared with the day admission cases. The patients’ feedback reflected that outpatient ITS had provided good environment, smooth discharge arrangement and clear discharge education. In summary, the streamlined outpatient ITS service significantly improves patient journey, enhances effective use of hospital bed, decreases access block in Emergency Department and the overall cost paid by each service user. Similar models are applicable to other departments to improve patient satisfaction, and to make good use of the limited resources.

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