Process Improvement Intervention to Reduce Ophthalmologic Surgeries Canceling and Patient Complaints

Abstract

Purpose: : This study aim to describe a quality intervention program to reduce the rates of ophthalmologic surgeries canceling and patient complaints.

Methods: : The study was carried out in a university hospital of the state of São Paulo, Brazil. The intervention occurred from July to December, 2007. The methodology applied was based on the model of process improvement. A multidisciplinary work group was instituted composed from professionals from all the stages at the line of the surgical care and coordinated by the Quality Program staff. The goals of the project were: to reduce the rate of surgeries canceling and to reduce the number of patient complaints. An action plan was established based on the analysis of main causes of the problems. The tools used included the worksheet 5W2H and a formal contract for the project. The rates of surgeries canceling before and after the intervention were compared using the chi square test and significance was assumed if P was less than .05.

Results: : In the baseline period (2004-2005) the monthly rate of surgery canceling ranged from 32 to 45%. In the year 2006 there was a plenty of problems, hanging this rate up to 38 to 66%. The main causes for surgeries canceling were: patient absence (33%), fails in the surgical products provision (32%) and unpropitious clinical condition (15%). The patient absence was reduced throughout the improvement in communication among resident surgeons and social assistance team. It was achieved modifications in the provision chain for essential surgical products (intraocular lens, balanced salt solution, viscoelastic solution) and there was no more surgeries canceling caused by this fail. Although there was no change in the overall rates of surgeries canceling between the baseline period (37%) and the intervention period (38%), the rates decreased compared to the year 2006 (51%) (P = 0.0001; RR: 0.75; IC: 0.71-0.78). The main cause of the patient complaints was the surgery canceling; the physician-patient relationship took part in many complaints. Specific training to improve this relationship was done. Patient complaints dropped from up to 20 in 2006 to about 10 per month in 2007.

Conclusions: : The methodology of process improvement showed to be useful to reduce the main causes of surgeries canceling and patient complaints. The work group expressed high level of satisfaction regarding the methodology applied and the goals achieved.

Keywords: clinical (human) or epidemiologic studies: health care delivery/economics/manpower • clinical (human) or epidemiologic studies: systems/equipment/techniques