Reducing Average Time from Diagnosis to Application of Definitive Orthoses for Patients
Care Continuum
Care Process & Redesign
National University Health System Quality Improvement
National University Health System
31 December 2024
Reduce average time from diagnosis to application of definitive orthoses (i.e. The intervention shows promise for improving patient care by reducing the time to application of definitive orthoses and improving.
Year Submitted: 2024
Published Date: 31 December 2024
Tags: Care Process ＆ Redesign, Access To Care, Waiting Time, Care Continuum, Workflow Redesign
About this Content
Aims
Reduce average time from diagnosis to application of definitive orthoses (i.e. short walker boot or air-cast boot) in adult patients (≥16 years old) with radiologically-proven metatarsal fractures seen in the ED by at least 25% from 7 days to 5 days, by September 2024.
Background
For patients with metatarsal fractures treated in the Emergency Department (ED), an above ankle plaster cast is typically applied, with a follow-up appointment given at the specialist outpatient clinic (SOC). The single-use ankle plaster cast will be removed when the patients are re-evaluated at SOC. As closed metatarsal fractures are mostly treated conservatively, these patients will be fitted with the short air-cast boot as the definitive treatment. Application of air-cast boots in ED represents an opportunity to improve clinical outcomes and patient experience by enabling earlier definitive treatment while avoiding skin complications or reattendance issues.
Methods
Using the fishbone diagram, the team identified the following root causes. Potential solutions to address the root causes were then ranked and implemented according to the Impact vs Implementation matrix. Strategies to spread change after implementation included increasing par levels of the air-cast boot, appointing air-cast workflow champions, fast-tracking patients, and planning methods to evaluate and enhance patient experience.
Results
Significant reduction in average time taken from diagnosis to application of definitive orthoses from 7 days to 3 days (57% reduction) for ED P3 patients discharged with metatarsal fracture between 12 July to 19 August 2024.
Conclusion
The intervention shows promise for improving patient care by reducing the time to application of definitive orthoses and improving patient experience.
Lessons Learnt
1. It is important to consider all stakeholders’ perspectives in implementation of these initiatives, e.g. where to store the air-cast boots, and adapt accordingly.
2. Face-to-face reinforcement of new workflows may be necessary to help clarify doubts and concerns.
Additional Information
Additional credits to ADON Ng Wei Wei, NE Nurshafirah Suhaimi and the following nurse trainers (CM Nurul Amirah Anuar, SSN Kenny Tan, SN Muhammad Shafie, EN Kathleen Joyce, EN Siti Norsalina) for their assistance in the project.
Keywords
Definitive Orthoses, Metatarsal Fractures, Average Time (Diagnosis to application)
Innovators' Details
Innovators' Details
Healthcare Cluster(s) | National University Health System |
Organization(s) Involved | Ng Teng Fong General Hospital |
Platform(s) | National University Health System Quality Improvement |
Healthcare Professional Group(s) | Medical, Nursing |
Applicable Specialty or Discipline | Emergency Medicine, Orthopaedics |
Project Lead(s) | Koh Yiwen |
Project Member(s) | Chen Yong Sheng |
Connect with this contributor!
Dr Koh Yiwen - yiwen_koh@nuhs.edu.sg