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Gosford Surgical Admissions Centre Waiting Room Project

Project Added:
23 January 2015
Last updated:
25 February 2015

Gosford Surgical Admissions Centre (GSAC) Waiting Room Project

Division of Anaesthetics, Surgery and Intensive Care, Central Coast Local Health District

Summary

The Gosford Surgical Admissions Centre (GSAC) is a short stay surgical admissions centre providing care to 1350 elective patients per month. The project aim is to improve the patient satisfaction rate by focusing on communication, the waiting room environment, the admission processes and streamline documentation. 

Aim 

Improve patient satisfaction rates and reduce complaints.

Benefits

  • Improved patient satisfaction
  • Reduction in complaints and clinical incidents in the waiting room
  • Process improvements to manage patient elective admissions
  • Improved communication 

Project Status

Project started:  December 2013. 

Status: Sustained - the project has been implemented, is sustained in standard business. 

Implementation sites: Gosford Surgical Admissions Centre waiting room. Implementation has begun at Wyong Surgical Admissions Centre.

Background

It was identified that improvements were required for customer service and the waiting room environment. There were several complaints regarding poor communication between patients/carers and staff which related to elective surgery scheduling. 

Several clinical incidents occurred in the waiting room due to limited observation by staff.

  • Several patients reported sitting in the waiting room all day fasting for surgery, without a staff member acknowledging or providing updates on surgery delays
  • Several patients reported feeling cold and hungry 
  • Several patients complained about staff attitude and lateness of notification of surgery cancellation 
  • Several patients reported that staff appeared to have no understanding of what was happening when patients requested information
  • A patient fell in the GSAC waiting room
  • A patient was transferred to post operative care in the Intensive Care Unit without any communication with GSAC, relatives in GSAC waiting room.

Diagnostic phase

A diagnostic phase was undertaken using process mapping, patient surveys, consumer volunteer observational audits and a review of Incident Information Management System (IIMS) data.  

A route cause analysis identified four main issues requiring improvement: Communication, environment, admission processes and documentation. (See this presentation for more detail).

Implementation 

A working party with key stakeholders was convened. The PDSA (Plan, Do, Study, Action) methodology was used.

Environment

As a result of consumer feedback, several improvements to the waiting room environment were initiated, including, a toilet cleaning schedule, temperature adjustment to waiting room, new chairs and reconfiguration of seating for better observation, new television, current magazines and educational material. The carers unit was promoted as a place for carers to wait while their family member was in surgery. The aim was to reduce crowding in this small area and provide a restful place for carers to wait. 

Admissions process

A ticketing system was developed for the admission process, with the aim to reduce the lengthy queues at reception and improve patient privacy. Admissions clerical staff were provided with results of consumer feedback and the expectations of customer service were articulated at staff meetings.

Communication

The CCLHD has implemented the Caring for the Coast, “Every patient, every time” initiative, which is modelled on the Studer program. The expectations of this program, in particular customer service has been articulated to all staff. 

A rounding log was used by nursing staff to conduct regular rounding of the waiting room. Observational rounding and communication with patients and carers ensures staff are informed and responsive to any concerns regarding the elective surgery processes. The rounding log is reviewed and issues are communicated to surgical admissions staff at meetings.  

A flow chart was developed for the communication cascade when patients are delayed or postponed. A poster and whiteboard was displayed in the waiting room to inform patients and carers in the event of delays. CCLHD patient admission to hospital booklet has been updated to provide additional information to patients and carers regarding surgical scheduling and reasons for delays. 

Documentation

Admission documentation has been revised and streamlined to improve admission process and reduce duplication. 

Results 

Use of patient experience trackers (PETs), repeat patient satisfaction survey, repeat consumer observational audits and review of IIMS data has demonstrated improved satisfaction and a reduction of incidences. There was a significant decrease in IIMS complaints data in 2014 after this project was implemented.

 

 

Post-operative Phone Call Survey

Question Pre-project 'yes' Post-Project 'yes'

Was the day surgery/EDO process explained to you during the nursing admission interview  

93% 100%

Were you aware that there would be a 2-3 hour waiting period between your presentation time at the hospital and your operation/procedure time?

91% 99%
If you did have any concerns were they dealt with in a timely manner and to your satisfaction? 51% 100%
Is the layout of the waiting room seating/temperature satisfactory?   44% 100%

Pre project comments:

  • The toilets were filthy
  • The chairs were uncomfortable
  • The room was cold
  • No current magazines or reading material

Post project comments:

  • Everyone looked after us
  • I was nervous
  • Patient with back problems and they all cared for me
  • Slightly too cold
  • Wasn’t admitted at the time I was advised, and no one advised me re delays

Carer Feedback

Feedback from a carer was provided by the Carer Unit Manager:

David, a community visitor to the retreat while wife was undergoing surgery said a few things pleasantly surprised him:

“Today a person in scrubs came into the SAC waiting room and announced to everyone that if they had any concerns, questions, or were feeling that the wait is too long, to please tell the staff and the problem would be addressed.”

“After my wife went in to the unit, a staff member came and got me, and suggested that I take the time to go to Bunnings, or Gosford shops, or go to the Carer Retreat where I could relax, get a free cup of coffee and something to eat.  I took the latter option, and was delighted that I did.” 

A follow up consumer Observational Audit in November 2014 noted significant positive change in the room both for seating / design and processes for admission. The volunteers who visit on a daily basis get a sense that people are more relaxed and it appears that they are moving through the centre quicker.

Lessons Learnt

  • Using the project methodology can reveal that the initial solution is not necessarily the best. 
  • Ensure that the right people are members of the working party. 
  • Unless you engage staff the project won’t be sustained. 
  • Work out what is in scope for the project and out of scope or the project can become too large.

Resources 

These resources give more detail about the project: 

  • Presentation, including further information on the diagnostic process and the communication flowchart.
  • Poster, summarising the project.

Contact

Karen Schofield
Operational Nurse Manager
Division of Anaesthetics, Surgery and Intensive Care
Central Coast Local Health District
Phone: 02 4320 2214
Email: Karen.schofield@health.nsw.gov.au

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