Reduction in length of hospitalisation for microbial keratitis patients: a prospective study.
OBJECTIVE
Prolonged hospital stay in the course of management of microbial keratitis patients has been a burden to the resources of a multi-disciplinary tertiary hospital. The paper aims to evaluate the impact of streamlining the workflow and increased cross-disciplinary interactions on the average length of hospitalisation. It also seeks to study secondary outcomes including the average time for initiation of therapy, microbial culture positive rate, patients' satisfaction and resource savings.


METHODS
The authors employed the model of clinical practice improvement (CPI) (New South Wales Health Department) methodology for a systematic approach to improve processes of care and service delivery. A team consisting of ophthalmologist, microbiologist, pharmacist and nursing staff was formed to brainstorm and highlight the problems. A new workflow was formulated and data were prospectively collected to evaluate and to identify areas where improvements could be made.


RESULTS
The average length of hospitalisation stay was reduced from 7.43 to 5.93 days with a mean difference of 1.50 +/- 0.63 days (p < 0.05). The microbial keratitis culture positive rate increased from 54.6 to 73.0 per cent (p > 0.05). The average time taken to initiate antibiotic eye drops after first contact with the doctor was 26.1 minutes (n = 28), and 74.4 per cent of the patients surveyed were satisfied with their length of stay.


CONCLUSIONS
Intervention was carried out on the top 20 per cent of areas for improvement after voting by the team members.


CONCLUSIONS
The reduction in average length of hospitalisation can be improved by strict adherence to a formulated workflow and coordinated cross-disciplinary interactions.


CONCLUSIONS
The management protocol discussed in the paper for microbial keratitis enables more effective and efficient treatment for the inpatients. Increased cross-discipline and nursing coordination decreases length of hospitalisation of microbial keratitis patients and achieve better care for these patients.
Jimmy
Lim Wei Kheong
LW
Ophthalmology Department, Tan Tock Seng Hospital, Singapore. jimmy_wk_lim@ttsh.com.sg
Barkham
Timothy
T
Ming
Chen Qian
CQ
Lim
Lynda
L
Lin
Jia
J
Hong
Goh Lay
GL
Jin
Heng Wee
HW
D001424:Bacterial Infections / Q000175:diagnosis / Q000628:therapy*; D006801:Humans; D033183:Interdisciplinary Communication; D007634:Keratitis / Q000175:diagnosis / Q000382:microbiology* / Q000628:therapy*; D007902:Length of Stay; D009517:New South Wales; D019982:Organizational Case Studies; D010043:Outcome and Process Assessment, Health Care / Q000379:methods*; D011446:Prospective Studies; D057188:Workflow