Authors (including presenting author) :
Fong YL(1), Wong SY (1), Wong WK(1), To CH(1), Lui CT (1), Tan WS (2), Cheng SL (2), Poon YM(2)
Affiliation :
(1) Specialist Outpatient Clinic (NTWC SOPC), (2) HIRO Department, Tin Shui Wai, Pok Oi and Tuen Mun Hospital.
Introduction :
In 2019, Surgical doctor piloted Folderless Consultation in POH SOPD in August 2020. The feedback was encouraging. All stakeholders satisfied for the project. They would like to have "Smart on demand label printing" instead of pre-print labels. In TSWH, outpatient & inpatient clinical notes were put together in one medical record folder and weight of one record could be up to 2kg. The total height of medical record folder per year accumulated ~ 101 meter (TSWH), 398 meter (POH) and 377 meter (TMH), it was equal to ~36 storey high (TSWH); 142 storey high (POH) and 135 storey high (TMH). Hospital Information & Records Office (HIRO) staff should send those heavy medical folders enclosed with pre-printed labels from Record Office to SOPC registration counter the day before consultation. The weight of folder per year in TSWH (67658 kg), POH (265044 Kg) and TMH (251326 kg), it was equal to 28 cargo container (TSWH), 110 Cargo container (POH) and 104 Cargo container (TMH). Clinic staff would need to check patient’s identity against the medical record folders before which were sent into doctors’ consultation room. Paperless Consultation is one of the Smart projects in TSWH. Pre-printed A4 patients’ label and put into medical folder was one of the obstacles identified. The top management strived for the changes and Smart label printing function has been created and used in TSWH since 24/2/2021 which was a great mile stones for folderless consultation. The project was fully implemented in TSWH and POH on 12/4/2021 and 1/2022 respectively. ACC TMH has been started since 2/2022.
Objectives :
To minimize the outdated gum labels, hardcopy medical records storage in patients’ medical folder, the risk of manual handling & transmission of infectious diseases of staff. To eliminate the risk of losing patients’ documents To save the time in handling of patients’ loose sheet and filing documents. To enhance the efficiency of record transfer and clinic workflow. To become environmental friendly.
Methodology :
The top management proposed and briefed the project to concerned parties. All stakeholders were familiar with the project, all hardware (transparent zip big and label printer) and software (label printing function) were ready. No A4 size of patient labels should be printed by HIRO staff. Clinic staff would check patient’s identity against with the transparent zip bag included remote printer slip, loose sheet and filing documents if any. Medical record folders were standby in Registration office; doctor could review the medical folder immediately upon request. After the clinic session finished, supporting staff would collect the transparent zip bags with filing documents (if any)back to Registration office.
Result & Outcome :
The project was implemented with uneventfully. All doctors, nurses, supporting staff, clerical and HIRO staff welcomed for the project and improvement work. The transparent zip bag was much lighter than the original medical record. The weight of medical folders were reduced 1.5% in all SOPCs. The efficiency of record transfer, clinic workflow and Occupational safety were enhanced. The time saved to retrieve, file and transfer medical record folder from 3383 hour to 13252 hour (423 to 1657 working days) For environmental friendly, 584028 paper / 6.2 trees per year would not be required per year. The total height of medical record folders were significantly trimmed down to 10% per year, the storage space of hardcopy was saved. For patient identification, outdated hardcopy and gum labels were eliminated. As no doctor requested to review patient medical record 2 months after new workflow implementation, medical folder retrieval from HIRO to SOPC was suspended with effective from 15/6/2021. If doctor wants to review hard copy of medical record, it takes 3 minutes only for retrieving the folder for doctor. The way forward is to share these good practices to all SOPCs in HA.
