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How To Handle 1200
Patients per day
with Two Staff & Dawn AC - A
Survival Guide |
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Robyn Coleman, Sullivan &
Nicolaides Pathology, Queensland, Australia
Sullivan Nicolaides Pathology (SNP) is a private pathology practice
that services the east coast of Australia, from Coffs Harbour in New South
Wales to Cairns in Queensland. We have used DAWN AC for about 18 months
now and it has been integral in our ability to handle a large number of
patients safely and effectively. The patient database is approximately
7,000 active patients. The service holds current ISO 9000 and NATA
certification.
The process of care is as follows. At the point of sample collection,
patients complete a questionnaire that identifies any changes,
particularly to medications that may affect their warfarin management.
These notes are entered directly into DAWN and the patient record is
flagged. The sample is processed at any one of 20 laboratories that are
connected by a wide area network (WAN). As soon as the INR result is
authorised, the patient’s account number, surname, lab number and INR are
placed on a queue by our mainframe. This creates a data file that is then
imported to DAWN. The “ Match / Mismatch “ report is produced and any
failures dealt with.
We then run a “batch” calculation. Patients who have a “Miss 1 or 2
days” dose calculation are also flagged. The dose, date of next test and
home visit flag are extracted via 3 programs run by the batch builder in
Report Writer function of DAWN.
This file is then sent back to our mainframe and the report to the
patient’s referrer is printed. Patients are contacted either by dose
letter or by our results staff (from the mainframe), if they have a “miss
day” instruction, a dose change or a test within the next 5 days.
Flagged patients are reviewed by our physicians who may alter the
suggested DAWN dose based on supplied clinical notes. These are then
un-flagged to be sent back to the mainframe at the next upload. Our
intervention or doctor review rate averages 25%. An average day is between
600-900 patients.
We conduct regular audits looking at performance review and also to
identify patients who may require closer supervision. We are selective
about the patients who are eligible to our programme as we realise not all
patients are suited to our style of service. We also reserve the right to
discharge patients back to their original referrer if their needs can not
be meet by our programme or the patient self-medicates or fails to attend
four successive appointments.
The monthly audit for performance review looks at:
Patient Numbers (New, exited, nett growth)
Intervention (Physician review ) rate
Below / In / Above Target Range (approx 60% of INR in target range)
Events such as bleeds (minor or major) or thrombosis
INR >5.0
Test interval (Approximately 60 % have a test interval of equal or
greater than 2 wks, max 6 wks)
Patients with Compliance <30% and start date is greater than 3
months ago.
Dawn AC has enhanced the service that we offer our patients. We
frequently handle peaks of over 1200 patients per day. On one occasion
1200 patients were handed by just two staff.
The report writer allows us to easily extract information that we can
audit and monitor to maximise patient safety. Benchmarking has also been
invaluable in our effort to continually refine and improve our service.
While Dawn AC has been a journey of discovery throughout it’s
implementation, “she” has been a worthwhile addition to our Warfarin Care
staff.
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