The Cardiac Laboratory is a comprehensive facility providing a wide range of cardiac diagnostic tests and services for patients. Among these, the Transesophageal Echocardiogram (TEE) is one of the most frequently performed procedures. TEE is a diagnostic procedure that uses an ultrasound transducer inserted into the oesophagus to visualise the structures in the heart.

With approximately 780 TEE procedures conducted annually, the high volume requires cardiac technologists and nurses to reprocess the probes efficiently and effectively within a short turnaround time. However, this process is time-consuming and involves multiple steps. First, the team pre-washes the probe with filtered water and an enzymatic sponge to remove gross substances from the scope surfaces. Next, they soak the probe in a liquid comprising concentrated sterilant powder reconstituted with distilled water. During this step, staff have to wear full personal protective equipment (PPE) as the powder is potentially irritating, and manually document the powder’s batch number on the bottle. Finally, after proper soaking, the probe is rinsed and stored, or prepared for the next patient. The entire process takes the team 30 minutes to complete while simultaneously managing patient care duties.  

Recognising this strain, Cardiac Laboratory “gross-ed” the complex procedures into a simple, three-step wipe system while maintaining stringent reprocessing and decontamination standards. Now, the probe undergoes a pre-wash with water and an enzymatic sponge, followed by cleaning with a prepackaged wipe system. Finally, a batch number sticker from the wipe system is attached to the probe for tracking purpose. The updated process takes only 10 minutes, reducing the initial reprocessing cycle time by two-thirds. 

Beyond its time saving benefits, the new system improves workplace safety as it is non-hazardous to staff and the environment. “Since simplifying the process, we have managed to swiftly reprocess TEE probes, allowing us to dedicate more time and attention to patients and address their needs during the procedure,” says Senior Staff Nurse (SSN) Garcia Lezlie Valenzuela from Cardiac Laboratory. 

 

For the Process Transformation & Improvement (PTI) team, registering Quality Improvement (QI) projects was challenging due to the sheer volume of hardcopy paperwork required. This prompted them to walk the talk by reassessing this cumbersome ‘GROSS’ process and streamline it by phasing out hardcopy QI Initialisation forms and adopting the SingHealth Improvement Portal (SIP) to register projects for easy tracking and visibility. 

Previously, hardcopy QI Initialisation forms were physically routed to various stakeholders for signature endorsements. This posed a constant challenge as it required coordinating schedules across departments. Additionally, misplaced documents during transmission risked rework and duplication, resulting in delays.

Moving towards an online portal proved to be a step in the right direction, improving collaboration across departments. Relevant project approvers now receive immediate email notifications to approve project requests. It also provides QI representatives visibility of the project approval workflow. “With the implementation of SIP, we can easily monitor and track multiple project statuses at once,” Jacqueline Huo, Assistant Manager from PTI shares. She adds, “This allows us to provide timely follow-ups with stakeholders to meet project timelines.” 

GROSS doesn’t have to be complicated. As the Cardiac Laboratory and PTI teams have demonstrated, improving work processes does not always require complex overhauls. Often, the biggest impact comes from the simplest solutions.