Improving speech therapy ACDF workflow at the Pre-Admission Centre
Not Applicable
SingHealth
21 May 2025
To reduce time spent by STs in assessing ACDF patients from 30 minutes to 15 minutes, over a period of 4 months. Overall, the initiative effectively addressed the mission statement, improved patient care and optimized resources.
Year Submitted: 2025
Published Date: 21 May 2025
Tags: Ambulatory Care (Outpatient Care), Productivity
About this Content
Aims
To reduce time spent by STs in assessing ACDF patients from 30 minutes to 15 minutes, over a period of 4 months.
Background
Potential complications of anterior cervical discectomy and fusion (ACDF) surgery include temporary voice and swallowing difficulties, with dysphagia incidence estimated at 3.3% to 87.5% based on existing literature. In Singapore General Hospital (SGH), the dysphagia incidence is 42%. Educating patients about the incidence and risk factors for these complications is essential to pre-operative management. The ACDF clinical pathway at SGH includes swallowing assessment and info-counselling by Speech Therapists (STs) pre and post-surgery. However, there was no pre-arranged appointment booking at the pre-admission centre (PAC), which resulted in increased waiting time for patients. Referrals for ST sessions could also come any time, disrupting ST’s daily schedule.
Methods
We utilized the 5 WHY diagram to identify root causes of reduced efficiency and develop a new workflow. Upon patient’s arrival, PAC nurses distribute educational handouts and the Eating Assessment Tool 10 (EAT-10) questionnaire. Using predetermined criteria, patients are risk-stratified into phone vs face-to-face groups. For phone consultation patients, therapy assistants (TAs) conduct screening using the EAT-10 questionnaire and remind them to read the education handout. For identified higher risk patients, ST would provide face-to-face evaluation.
Results
We successfully reduced the average time spent by STs and TAs from 30 minutes to 15 minutes per patient. This has resulted in cost savings from the ST clinical resource perspective, as TAs can complete screening remotely for low-risk patients. Additionally, STs could allocate more time to urgent cases in inpatient wards and the overall waiting time for patients have also reduced. Pre intervention: 38, post intervention: 36
Conclusion
Overall, the initiative effectively addressed the mission statement, improved patient care and optimized resources. The department plans to continue using the new workflow beyond the project's completion, ensuring sustained benefits for both patients and STs.
Lessons Learnt
The implemented solution proved successful and sustainable, leading to permanent adoption of the new workflow. By reducing face-to-face contact time for pre-operation counselling and assessments, operational efficiency improved. This resulted in lower billable charges, creating a positive outcome for both the department and patients through streamlined service delivery and cost savings.
Additional Information
IPSQ Poster Excellence Award 2025
Keywords
speech, therapy, therapist, ACDF, anterior, cervical, spine, surgery, improve, process, preadmission centre
Innovators' Details
Innovators' Details
Healthcare Cluster(s) | SingHealth |
Organization(s) Involved | Singapore General Hospital |
Platform(s) | Not Applicable |
Healthcare Professional Group(s) | Allied Health |
Applicable Specialty or Discipline | Speech Therapy |
Project Lead(s) | Cheryl Lee Pei Sin |
Project Member(s) | Cheryl Lee Pei Sin |
Connect with this contributor!
Cheryl Lee - cheryl.lee.p.s@sgh.com.sg