Quality Improvement

So the past couple of days, I have been helping out with St. Francis’ Quality Improvement (QI) team. One of their main challenges that was put out by the Ugandan Ministry of Health (MoH) was to form these QI teams to look at how to improve the operations of the clinic. One other point that was made was that the average treatment time for a patient at a clinic is 40 minutes. So on Tuesday, I sampled two patients myself, while another German volunteer (the clinic now has two) followed other patients. I followed a young woman and a young man – both were there for ART refills since it was a clinic day. The young woman was waiting at the reception area when the clinic opened at 8:30am. She was called to see the clinician at around 9:07am. Her last CD4 test was listed in her file was dated August 2009 and was found to be 273 (normally St. Francis tests CD4 every 6 months but for some reason she did not have one recently). She was referred to the lab where a blood sample was taken and tested. The CD4 test is done by a machine that runs the sample and measures the CD4 count and takes a total of about 25 min to complete – including sample prep time. Her new number was now 176. She appeared normal but her immunity was more at risk than before and possibly indicated an adherence problem to taking the medication. Her results were discussed with the clinician and then she was prescribed her medication which was issued at the pharmacy. She left the clinic at about 10:20am. The young man was seated at the reception area around 9:25am. At 10:53am, he was referred to see a clinician. He also needed a CD4 test and was referred to the lab. His lab results showed that his CD4 was 591. His results were then discussed with the clinician. He was then prescribed his drugs by the pharmacy and left at 12:30pm. As one can see, the total treatment times are well above the MoH’s suggested standard. Both of these were relatively simple patient situations and if one needed counseling, the time can only increase. It is one of those issues where I wonder if people are more concerned with quantity over quality! It was a good opportunity for me to really learn how patient flow works at St. Francis.

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