Seamless care in Family Medicine Specialist Clinic (FMSC) monitoring system

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Abstract Summary
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Authors (including presenting author) :
Chan SC(1), Chan CY(1), Lau MP(2),Chan W(2),Yuen WC(2), Li YH(2),Wong HH(2), Lai SF(2), Tsang YT(3), Tso PS(4), Ho SF(5)
Affiliation :
(1)APN (2)RN (3)EN of Ha Kwai Chung General Out Patient Clinic (HKC GOPC), (4) WM (5)DOM of Family Medicine & Primary Health Care, Kowloon West Cluster
Introduction :
The role of FMSC is to alleviate pressure on SOPC. Ha Kwai Chung (HKC) is one of FMSC clinics to meet the growing demand (FMSC attendance in each financial year: 2015/16:15,660; 2016/17: 16,783; 2017/18: 17,763), and to uphold service quality and patient safety. In 2017 there are 15,325 cases attended FMSC at HKC with 15.85% default rate. It is an unexpected wastage. To better manage demand and capacity, HKC implemented initiatives to decrease default rate by pre-consultation monitoring system.
Objectives :
To allay high default rate and uncertain investigation date and report of FMSC, HKC nurses implemented pre-consultation monitoring systemn in the beginning of 2018. FMSC capacity was strengthened by shortening consultation time, tracing investigation date and report and increasing attendances. The system supported patient safety, matched demand with capacity, improved resources utilization and minimized patient waiting time.
Methodology :
1. If patients missed appointments for blood test or investigations in private clinics, arrange related investigation or test. 2. Retrospective data before and after implementation was drawn from CDARS to check changes of default and utilization rate. 3. Doctors feedbacks were collected regularly. 4. Patient survey from September to December in 2018 evaluated satisfaction in: (1) instructions on workflow, (2) workflow explanation, (3) waiting time for consultation, (4) clear instruction and explanation by nurse via phone if applicable, and (5) overall services.
Result & Outcome :
1. Default rate of FMSC decreases either new referral or subsequent case. Default rate decreased from 15.8% in 2017 to 15.2% in 2018, and surgical cases decreased from 17.6% to 15.7%. 2. The system streamlines patient flow resulting in larger FMSC capacity that booked cases/attendance increased from 18,211/15325 in 2017 to 18,644/15808 in 2018, with no increase in doctor sessions or quota. Thus with the system clinics can accept more patients. 3. 80%/20% of 100 patients were very satisfied/satisfied with staff instructions, waiting time, nurses' calls after treatment and prior to follow up, and FMSC overall servics, agreeing nurses' reminder reduce their time and money wasted.

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