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G455(P) Improving access and quality of diagnostic services in a developmental and behavioural service for pre–school children – the triage–track model
  1. S Singhal,
  2. HH Lim,
  3. AK Chua,
  4. LM Daniel,
  5. SB Lim
  1. Department of Child Development, KK Women’s and Children’s Hospital, Singapore

Abstract

Aim The Department of Child Development (DCD) at our hospital is the major diagnostic and interim intervention service provider for pre–school children with developmental and behavioural disorders in our country. With increased public awareness and emphasis on early detection, the demand for our services has risen tremendously. This was not met with the traditional medical model of multi–disciplinary service delivery. We implemented a novel triage–track inter–disciplinary service model to enhance access and quality of services. This paper presents our 4–year experience with the triage–track model from June 2010.

Methodology Through cause and effect analysis, a triage workgroup identified progressive solutions to improve case–differentiation and service prioritisation. The measures streamlined and defined were: 1) secondary screening and case management pathways in the triage clinic, 2) tertiary diagnostic and interim intervention model for specialised tracks [Learning and Behaviour (LB) track, Autism Spectrum Disorder (ASD) track, and Complex track], 3) documentation standards for continuity of care, 4) interdisciplinary professional roles which promoted cross–disciplinary learning. We conducted three Plan–Do–Study–Action (PDSA) cycles (Oct 2010–Nov 2012) before embarking on installation (Dec 2012– Mar 2013) and full implementation (since April 2013).

Results The average monthly wait–time (interval between primary care referral to first DCD visit) improved by 84.2% with the triage–track model [pre–implementation 139 days (June 2010) versus full–implementation 22 days (June 2014)]. In 2012, the triage–track model improved operational capacity by 67.9% compared to the Traditional model [4.7 patients/triage–clinic session (n = 1355) versus 2.8 patients/traditional new-case session (n = 799)]. In 2013, 32.2% patients were referred to the specialised tracks for tertiary diagnostic evaluation and management (ASD: 19.2%; LB: 11.7%; Complex: 1.3%). The ASD track achieved significant improvement in wait–time and cycle–time for ASD diagnostic evaluation and family-centeredness of services. The LB track enhanced comprehensiveness of diagnostic evaluation and fast-tracked 21% of evaluations for patients. In the complex track, all patients completed full evaluation as targeted within a 6-month period.

Conclusion The interdisciplinary triage–track model improved access to services, enhanced operational capacity and quality of care in our centre.

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