1. TAN TOCK SENG HOSPITAL
PRABHAKARAN LATHY
To Reduce Default Rates At A Fast Track Asthma Clinic (FTC) In TTSH.
Poster No:
BP-QHSR 15
LATHY PRABHAKARAN, JANE C, ABISHEGANADEN J, LIEW N L, FATIMAH S, LIM G H, TAN W L, Nursing Service, Respiratory Department, Emergency Department, Tan Tock Seng Hospital Singapore.
Aim:
To reduce the default rate of referrals from ED to the Fast Track asthma Clinic (FTC)* from the current 50% to less then 10% in 6 months.
Methods:
FTC was initiated in 2004 for patients seen at ED with poor asthma control to be fast- tracked (expedited) to this clinic to stabilize and optimize asthma control quickly. At FTC patients are reviewed within two weeks instead of waiting for 4-7 weeks to be seen at respiratory specialist clinic. The mean default rate at the FTC was 50 %. Using Clinical Practice Improvement methodology, we identified the main causes to be “patient forgets appointments”, “patient’s don’t call to cancel or change appointment” and “not being able to contact patient to confirm their attendance”. We reinforced on updating telephone numbers at different contact points at ED. We called patients one-day prior to their appointments to confirm show and arranged for call centre to contact patient that were not contactable during office hours.
Results:
With these interventions, our default rates were below 10%. There were significant reduction in ED visit (1.23 to 0.41) and hospitalization ( 0.27 to 0.04) 3 month prior and post FTC visit (P <0.001). However the gross cost incurred in ED visit ($ 489 to $1028) and hospitalization ($489.1 to $1028.6) 3 month prior and post-FTC was not significant ( P= 0.51; P = 0.25). In terms of demography, we found that Malays were 2.6 (95% CI:1.2 –5.5) times more likely to default, as compared to Chinese (P=0.012). In terms of age the relative risk ratio of default decreased by a factor of 0.96 (95% CI ) for every year increase in age (P=0.001).
Conclusion:
Frequent communication and creating partnership with patients and providers are vital to reduce default rates and demonstrated improved outcomes for patients and the health care system.