HAWKS- a pre-consultation kiosk for patients with URTI Pilot - Woodlands Polyclinic Phase 1 ( May 2012 )
Managing the load : lane traffic ? Over 650 walk-ins a day Almost 150 – 200 of them having URTI What if we separate them, send them to 2 or 3 rooms ? They would be seen faster, and leave the clinic faster. Better yet, what if I could pass on the information I get from them ( while segregating them ) to the end user : the doctor ? More time saved !
Screening and Registration Recipe Card# Work Sequence Standard1 Screen at ATT Kiosk Ask Pt: 1. Sir / Mdm, do you have Cough, Cold, Flu, Fever, Sore Eyes or Diarrhea? 2. If Pt has Flu, Fever, Sore eyes or Diarrhea scan IC for Q ticket & direct to Screening 1 Station2 Screening 1 Station (URTI Symptoms / Diarrhoea / „Sore Eyes‟ Patient ONLY) 1. Check Temperature 2. Write temperature on Q Ticket 3. Handoff Pt to Screening Staff3 Screening 1 Declaration Ask Pt: 1. Are you here for a Referral or Long Term Medication 2. Any Cough, Running Nose or Sore Throat 3. Any Fever 4. Any Diarrhoea 5. Any „Sore Eyes‟ 6. Does he need a Medical Certificate (If no, refer to OTC) Direct Pt to Waiting Area & wait for Reg Counter 1 or 2 to call.4 Exchange 2XXX with 5XXX Exchange Queue Ticket 1. Patient eligible for Blue Cluster to exchange 2XXX Queue number with a 5XXX 2. Staple a 5xxx number together with the 2xxx number. Ask patient to hold on to a duplicate 5xxx Q number. 3. Ask patient to drop off the stapled 2xxx and 5xxx on a tray at the dedicated counters 4. Ask patient to wait for his 5xxx number to call to be registered.
Recipe Card (Cont.)# Work Sequence Standard5 Registration Counter Ask Pt: 1. Call 5xxx Pt on Q panel 2. Collect Pt 5xxx Q ticket 3. Pt Identifier 4. Sir/Mdm I‟m going to ask you some questions to make your Dr visit smoother 5. Do you have any other complaint that requires attention by the Dr? 6. Are you here to request a hospital referral? Patients who answer YES to 5 or 6, assign to normal acute cluster Dr6 Reg – URTI Patients Ask Pt: 1. Have you had fever for more than 4 days? 2. Have you had fever >38C during this illness? 3. Do you have Diabetes, Stroke, Heart or Lung Disease or are you taking any medicine for cancer? 4. Any history of Asthma? 5. Document all information into PSA template7 Reg – Keying into Enotes Enotes 1. Copy & Paste Standard Template into Pt‟s Enotes Free Text 2. Edit the information in the template according to the answers given by the patient 3. Save the information keyed into Free Text8 Reg - Closing 1. Assign Patient to Blue Cluster Dr 2. Print out Service Chit 3. Give Patient Service Chit 4. Direct Patient to L2 Blue Cluster
Project Overview A self-help kiosk for patients to Answer basic health questions relating to medical history and clinical symptoms related to URTI Measure vital signs Upon patient being called, transfer all answers directly into doctors electronic notes Future Application Allow remote consult during pandemic outbreaks Allow patient education to take place and improve health literacy level
Proposed Flow (Pilot Phase 1) Q-Ticket Staff registers Dr sees patient, Patient Patient scans / generated Patient waits Does and assigns prescribes presents at keys in MRN (2XXX Counters 3-5 patient has patients to medication and Pre-Reg No. Series) N for URTI? Non-URTI enters consult notes Kiosk Registration Cluster in Aurora Y Patient issued 5XXX series Q-No and waits for Dedicated Reg Counters 1-2 Counters 1-2 calls 5XXX Q- No. to register/assign patient to End Rms 46-47 “Blue Zone” and directs patient to HAWKS Kiosk Patient goes to Pharmacy for prescription/payment Patient begins answering HAWKS Kiosk Questions End Changes made HAWKS Kiosk Patient is sent back in Pilot Phase determines if patient to Counters 1-2 to eligible for “Blue be reassigned to N another cluster Zone?”Note: Y1. Patient has to be registered for visit Patient’s “Blue Zone” Doctor calls info to be “fired” to all downstream Patient proceeds to interfaces. Temperature/Weight patient and opens patient’s taken by HAWKS wait at “Blue Zone” clinical notes with2. 5xxx series number acts a sequencer Kiosk and Data waiting area for HAWKS data and for dedicated Registration gathered from Kiosk Consultation. proceeds with consultation.3. Kiosk would be aided by a HA during flows to Aurora initial pilot phase.
Workflow – simplified viewPatient Obtains No. from ATT Patient has to be registered before data from kiosk can flow to Other Aurora Complaints Waits for RegistrationPSA asks for purpose of visit with General Pool URTI Complaints Dedicated PSA Sent to Passes Acute VSM Criteria Maintains room Registration & assigned to Acute Hawks assignment and consults Kiosk Acute VSM Doctor VSM Doctor Fails Acute VSM Criteria, sent back to PSA & reassign to Acute Cluster
HAWKS Kiosk QuestionnairesReiteration Question1) DO YOU HAVE COUGH, RUNNY NOSE, SORE THROAT WITH/WITHOUT FEVER ? ( Yes - Proceed. No - Exit from kiosk flow )Exit Questions1) DO YOU HAVE ANY COMPLAINTS OTHER THAN COUGH/RUNNY NOSE/SORE THROAT +/- FEVER ? ( No - Proceed. Yes - Exit from kiosk flow )2) DO YOU NEED A REFERRAL OR DO YOU NEED TO TOP-UP YOUR (CHRONIC) MEDICINES ? ( No - Proceed. Yes - Exit from kiosk flow )3) ARE YOU PRESENTLY TAKING ANY MEDICINES/INHALERS FOR ASTHMA ? ( No - Proceed. Yes - Exit from kiosk flow )
HAWKS Kiosk QuestionnairesActual data gathering at the Kiosk(Data has to flow in sentence format to “Subjective Section” of the Doctors eNotes)1) DO YOU HAVE COUGH ? IF YES, FOR HOW MANY DAYS ?2) DO YOU HAVE RUNNY NOSE? IF YES, FOR HOW MANY DAYS ?3) DO YOU HAVE SORE THROAT ? IF YES, FOR HOW MANY DAYS ?4) DO YOU HAVE A FEVER ? IF YES, FOR HOW MANY DAYS ?5) DID YOU CHECK YOUR TEMP AT HOME ? WHAT WAS THEMAXIMUM TEMPERATURE DURING THIS ILLNESS? ____6) PRESENT TEMP ___ C
Appearance in „e-notes‟ Final appearance by Phase 2 would be grouping of symptoms according to duration, with longest mentioned first; for eg :“ Runny nose and Cough for 4 days”“Sore throat for 2 days”“Fever for 1 day” Another example:“Runny nose and Sore throat for 3 daysNo cough. No fever.”