Authors (including presenting author) :
Lui MH(1), Fong PWK(1), Chan OHL(1), Fung KHW(1), Yeung AKC(1), Siu EHK(1)
Affiliation :
(1)Physiotherapy Department, Prince of Wales Hospital
Introduction :
Physiotherapy plays an important role in the management of paediatric scoliosis. Early interventions are essential in preventing the deterioration of condition. In Prince of Wales Hospital, the services provided to scoliosis patients have been in the forms of back care and exercise class. The number of referrals nearly doubled from 300 in 2015 to 595 in 2018. The waiting time for patients increased dramatically from approximately 2 months in 2015 to at most 8 months in 2018. Patients’ conditions would be worsened consequently.
Objectives :
To shorten the waiting time for scoliosis patients receiving Physiotherapy while maintaining the service quality.
Methodology :
Triage stratified care was used in the new model of service. Originally, four sessions of scoliosis classes were arranged for paediatric scoliosis patients despite the degree of severity. In the reformed class, patients were first stratified into two groups (low/ moderate to high risk) according to their risks of progression. The risk of progression was calculated according to the widely adopted formula included progression factors of Cobb angle, Risser sign and age. Classes of different sessions and formats were arranged to patients accordingly. LEAN concept was adopted to streamline the workflow. The key root cause for the long waiting time was identified through cause and effect analysis. Redundant assessment procedures were streamlined. The value added processes were identified through process value analysis. Comparing with the original model, the most value added components like patient education and empowerment were retained. The outcomes were evaluated using the waiting time and knowledge gain through quiz.
Result & Outcome :
36 cases of low risk group joined the reformed class. 40 cases of original class model in 2018 were randomly selected for comparison. The average waiting time was shortened significantly from 112 days in original model to 24 days in the reformed classes (independent t-test p<0.01). For the knowledge gain, the average gain in score for the quiz in the reformed classes was 13.7% which was similar to that of the original classes, i.e. 10.8% gain (independent t-test p=0.571). To conclude, with triage stratified care and LEAN approach, the reformed scoliosis classes siginificantly shortened the waiting time for the low risk patients while service quality was maintained.
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