oa Prioritizing Access to the National Diabetes Center NDC Services Based on Clinical Need

NDC is one of the busiest services at Hamad General Hospital (HGH) with 450-1000 new referrals monthly and an average waiting time of 84 days for an initial appointment. Triage guidelines from several government institutions in Canada, UK, and Australia stated that the patients with urgent conditions should be assessed within 2 weeks. Delaying urgent cases management poses a great patient safety risk that may endanger patient health and can lead to increased healthcare cost. In December 2016, a multidisciplinary team (physician, nurses, administration, and quality staff) was formed to pilot an urgent clinic service. The team standardized triaging criteria, calculated waste, and improved the process from triaging until the first appointment at NDC. Goal: To provide timely diagnosis and management for newly-referred patients to NDC who are considered urgent after physician's triage. Team Aim: To improve the percentage of referred patients with urgent cases who attended their initial consultation visit at the Diabetes-Endocrine Urgent Clinic within 2 weeks from physician's triage to 60% by May 2017. Methods: An urgent clinic exclusively for indicated urgent new referrals was piloted last December 2016. Fishbone diagram and process map were created. For testing changes, the Model for Improvement or Plan-Do-Study-Act (PDSA) was utilized. Several trials were done to identify the cases to be considered urgent during triage, manpower, clinic scheduling, appointment booking process, feedback gathering, and data collection. Results:For the past 9 months, there were 769 patients triaged to the urgent clinic. Around 65% of them were seen within 2 weeks, 12% no-show, and 23% were unable to attend due to various causes. We were able to surpass our goal for several months starting from January 2017 with the exemption in June 2017 when the clinic was closed for 10 days due to the Eid holidays.