Andrea Arathoon – University of Michigan School of
Public Health
Tuesday was a very exciting day because I reached a
milestone in my summer project! After 8 weeks of work, we started testing the
new outpatient care checklists for prenatal visits.
During the past few weeks we’ve been working on
developing this checklist to improve patient flow within the outpatient clinic.
Currently, waiting times can be longer than expected due to certain
inefficiencies in patient flow, and we
anticipate that the new care checklists will address these issues. We are also
making sure that Jacaranda Maternity follows WHO and Kenyan Ministry of Health
guidelines on prenatal care. After designing the new outpatient checklist, we
consulted with physicians, nurses, patient care assistants and the
administrative staff to ensure that the document was complete and easy to
understand, and that it served its purpose of being a decision-support tool for
clinicians during the prenatal visits.
Two weeks ago, we made the last changes to our
prototype checklist and trained nurses, patient care assistants, and
receptionists on this new tool. What I hadn’t considered was the fact that
printing of the checklist would take time, because the process is a bit slower
than I expected. This delayed the project by over a week. We finally received
the printed files on Monday afternoon, and we started the testing period Tuesday
morning.
At the same time that we rolled out this prototype
checklist, we also implemented a new document called “Patient Reminders”. This
idea came up after my week of observing the outpatient flow. When patients come
for their prenatal visits, they bring a “Maternity Card” which is a booklet
that contains all the relevant information about the patient’s pregnancy in
case she needs to visit another health facility during pregnancy or for
delivery. Patients understand the importance of this Card, and make sure to
always have it with them when they seek care.
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| Picture of the outpatient checklist and my mid-morning snack - coffee and Kenyan chapati |
This Card is also important because nurses write the
tests that are needed to be done before the patient’s next visit. There is just
one problem with this care model: no one is held accountable for ensuring that
the patient gets the tests she needs before she sees the nurse. And if she
doesn’t get a test done before seeing the clinician, she might have to wait
much longer because she needs to go back to the laboratory or ultrasound, wait
for results and then return to her outpatient consultation. Receptionists are
supposed to check the Card when the patient checks-in, but for many different
reasons this is not always done.
The “Patient Reminders” document is meant to solve
that problem. The document is small (about ¼ of a letter-sized paper) and is
designed as a checklist. Now, when nurses see a patient, they only have to
check the boxes for the tests that are needed before the next visit, and when
the patient checks-in next time, receptionists have a much easier way of
identifying the tests that were prescribed on the previous visit.
The new outpatient checklist tool for prenatal
visits and the patient reminders document will be tested for the next two
weeks, and we will make any adjustments needed after this trial period so that
we can implement the final outpatient checklist and reminders document in the
coming weeks. This outpatient checklist is the first step in moving the
patient’s file to the EMR that was implemented approximately one month ago. The
idea is to utilize this paper checklist while the hospital begins the process
of redesigning the clinical portion of the EMR. Once the checklist has been
incorporated into the EMR, clinicians will be able to take full advantage of
the benefits of utilizing the system as a decision-support tool that aids them
in their decision-making process.
