Reducing Appointment Time to Orthopaedic Specialist Outpatient Clinic for Emergency Department Patients with Fractures and Dislocations

Summary: Increasing patient visits to the emergency department (ED) at Sengkang General Hospital led to overbooking in the orthopedics specialist outpatient clinic. This delayed follow-up care for fractures and dislocations, which in turn impacted timely patient management. A quality improvement project aimed to increase the percentage of ED patients with fractures and dislocations who receive follow-up appointments within two weeks to 80%. An initial audit revealed that only 20% of patients received follow-up appointments within the target timeframe. Root cause analysis identified several key issues: junior ED doctors, with varying levels of system-based knowledge, often overbooked appointments; communication between doctors and administrative staff was inconsistent; and demand for orthopedic appointments exceeded availability. Two Plan-Do-Study-Act (PDSA) cycles were implemented. PDSA 1 focused on reducing demand through appropriate referrals and scheduling duration, while PDSA 2 increased clinic availability by adding more appointment slots. Together, these interventions led to a sustained positive change. After PDSA 1, performance initially improved but then declined. PDSA 2 produced a statistically significant, sustained improvement, with performance stabilizing above the targeted 80%. Regular audits continually track progress, and new doctors are provided guideline briefings. Patient satisfaction feedback is also being reviewed. This PDSA approach could be applied to similar specialist clinic appointment wait times issues.