Reduction in length of hospitalisation for microbial keratitis patients

Lim Wei Kheong Jimmy (Tan Tock Seng Hospital, Singapore)
Timothy Barkham (Tan Tock Seng Hospital, Singapore)
Chen Qian Ming (Tan Tock Seng Hospital, Singapore)
Lynda Lim (Tan Tock Seng Hospital, Singapore)
Jia Lin (Tan Tock Seng Hospital, Singapore)
Goh Lay Hong (Tan Tock Seng Hospital, Singapore)
Heng Wee Jin (Tan Tock Seng Hospital, Singapore)

International Journal of Health Care Quality Assurance

ISSN: 0952-6862

Publication date: 2 October 2009



Prolonged hospital stay in the course of management of microbial keratitis patients has been a burden to the resources of a multi‐disciplinary tertiary hospital. The paper aims to evaluate the impact of streamlining the workflow and increased cross‐disciplinary interactions on the average length of hospitalisation. It also seeks to study secondary outcomes including the average time for initiation of therapy, microbial culture positive rate, patients' satisfaction and resource savings.


The authors employed the model of clinical practice improvement (CPI) (New South Wales Health Department) methodology for a systematic approach to improve processes of care and service delivery. A team consisting of ophthalmologist, microbiologist, pharmacist and nursing staff was formed to brainstorm and highlight the problems. A new workflow was formulated and data were prospectively collected to evaluate and to identify areas where improvements could be made.


The average length of hospitalisation stay was reduced from 7.43 to 5.93 days with a mean difference of 1.50±0.63 days (p<0.05). The microbial keratitis culture positive rate increased from 54.6 to 73.0 per cent (p>0.05). The average time taken to initiate antibiotic eye drops after first contact with the doctor was 26.1 minutes (n=28), and 74.4 per cent of the patients surveyed were satisfied with their length of stay.

Research limitations/implications

Intervention was carried out on the top 20 per cent of areas for improvement after voting by the team members.

Practical implications

The reduction in average length of hospitalisation can be improved by strict adherence to a formulated workflow and coordinated cross‐disciplinary interactions.


The management protocol discussed in the paper for microbial keratitis enables more effective and efficient treatment for the inpatients. Increased cross‐discipline and nursing coordination decreases length of hospitalisation of microbial keratitis patients and achieve better care for these patients.



Wei Kheong Jimmy, L., Barkham, T., Qian Ming, C., Lim, L., Lin, J., Lay Hong, G. and Wee Jin, H. (2009), "Reduction in length of hospitalisation for microbial keratitis patients", International Journal of Health Care Quality Assurance, Vol. 22 No. 7, pp. 701-708.

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Copyright © 2009, Emerald Group Publishing Limited

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