Patients in the out-patient departments of three Queensland hospitals now follow kiosks that direct them between different services within the departments, cutting down on the amount of time they need to spend in clinics.
Redcliffe Hospital's specialist out-patient department (SOPD) offers orthopaedics, surgical, gynaecology, fracture, medical and private practice to 45,000 patients per year.
It was having problems with patient flow, with patients getting stuck in the hospital for hours on end, being transferred from one section of the hospital, such as medical imaging, to another. Patients arriving would face a queue of 20 to 30 people, just to register their presence at the hospital. Then they would have to wait while nurses alerted the consultants that the patient had to see. A patient's visit might also involve multiple visits back to the administration desk to facilitate their moving between service areas. In order to tackle the issue, the hospital decided to hold a tender process to see what vendors had on offer to handle patients' visit from referral, through consultation to discharge.
Thoughts ran towards giving patients barcodes to help their flow through the hospital. One vendor suggested a PC attached to a barcode scanner, and another suggested handheld barcode scanners to be used by staff. However, the system that the hospital decided on — to be provided by Motorola Solutions, Barcode Dynamics and Health IQ — involved a self-serve kiosk running a patient automated arrival system, which linked to the hospital's iSoft Hospital Based Computer Information System (HBCIS).
In December 2009, the hospital went live with the first phase of the system, which saw patients sent a barcoded patient appointment letter, produced by HBCIS. Patients would enter the SOPD and scan their letter at the Motorola kiosk to register their arrival. The kiosk would show them where their specific clinic's waiting room is.
In August 2010, workflow functionality was enabled in the arrivals system, telling staff when patients arrived in waiting areas and pulling up their medical data. Staff could follow all the moves that patients made in their department via an interactive dashboard linked to HBCIS through an interface developed by Health IQ.
The third phase, which went live in February 2011, involved the installation of a magnetic swipe card facility in kiosks to enable patients to swipe their Medicare and Department of Veteran Affairs cards. If the consultation is covered by the cards, the kiosk tells the patient which area of the hospital to go to next, but, if payment is required, then the patient is told by the kiosk to go to the administrative kiosk to sort out funding.
Through this facility, the hospital saved $22,000 in one month in the antenatal section, according to Kristy Brown, patient administrations systems manager, Redcliffe Hospital, who said that prior to phase three going live, the amount and complexity of patient information meant that it was easy for staff to forget about payments that needed to be made. Now, the patient isn't sent onto the doctor until after they've made arrangements for payment.
When the system was first installed, the hospital had been told to expect 40 per cent of patients to use it correctly. However, Brown said that 90 per cent of patients were able to use the system the first time. Now 97 per cent use it on arrival, with patients taking well to the system.
"They like to be able to do it for themselves," she said.
Queue lengths had fallen, as had patient time spent in the department, according to Brown. For example, the average total consultation time for fracture clinic patients was now one hour and 43 minutes, down from an average of three and a half hours. The number of visits that a fracture clinic patient had to make to the administration desk had also fallen from 13 to three. Staff had 20 per cent more time now to do other things, Brown said.
The hospital had spent a lot of time setting the system up, according to Brown, deciding on how it would work. The hospital spent about $50,000 on development by the vendors to get what it wanted.
One of the reasons for going with the product was security, according to Brown, but the main consideration was that the automated arrival system by Barcode Dynamics was the only one that could integrate directly with HBCIS.
"We needed a solution that would interface with our patient administration system — HBCIS," she said.
The kiosk-based arrival system is now live in three hospitals: Redcliffe, Caboolture and Mackay. The corporate office is also now looking at the system, to decide whether to roll it out to other hospitals.
The functionality of the system could also be expanded, she said. One of the hospitals is currently trialling an SMS barcode, which could be turned on at the other hospitals. There is also a translation function that could be turned on, which would provide information in the patients' chosen language — and, once chosen, would be recorded for future use with the patient.