Shifting to patient-focused care as a way to improve efficiency has surfaced in another Dunedin Hospital project as outpatient services are put under the spotlight.
A review of outpatient services was started earlier this year and some similarities to a project under way in the hospital's emergency department are starting to emerge.
The "optimising the patient journey" project being piloted in the emergency department is based on the simple premise of putting the patient first. Lead clinician emergency department specialist Tim Kerruish believes aiming for perfect patient care when looking at how and why everything was done will transform the hospital and save up to 50% wastage.
Otago District Health Board project manager Graham Bugler said the need for a review of outpatient services became apparent after increasing patient frustrations about booking systems for appointments.
Outpatient clinics are run independently in 26 different locations around the hospital and there is no co-ordination between services.
Last month, 7.4% of patients did not turn up for their first appointment with a specialist and one of the main reasons patients failed to turn up for appointments was they had no choice in appointment times, he said.
Patients are sent an appointment time and if the time did not suit it often was not easy to change as most clinics would be full.
Rural patients in particular had expressed frustration at being given early or late appointments, or appointments in different clinics on different days.
Overseas experience, where hospitals had changed systems to patient-focused booking and allowed patients to make their own appointments, had shown dramatic improvements in attendance rates, which meant less administration work on rebooking appointments, and improved clinical productivity, Mr Bugler said.
Outpatient clinics in Dunedin handle about 197,000 appointments in a year.
The impending introduction of a new patient management system next year meant there was also a need to standardise booking processes across all services. The new computer system will enable staff to see patient infor-mation such as all appoint-ments and referrals.
A stock-take and analysis of existing administration practices has been com-pleted.
Innovations which had been successful in other hospitals were being examined by the project team, such as creating a centralised booking service or building an outpatient superclinic to enable all clinics to be held in the same location.
However, Dunedin Hospital was constrained by physical space, Mr Bugler said.
Group manager Pip Stewart, who is overseeing the review, said the team would eventually produce a set of recommendations of what they thought would work in Dunedin.
The project team was still establishing "guiding principles", but suggestions from the board's hospital advisory committee included not making change for change's sake, more patient-focused care, rationalising office space to increase clinical space, which is at a premium in Dunedin, and looking at which services may be better provided in a community setting rather than in the hospital.
