Reducing Patient Wait Time at the Emergency Department with Technology — tED
As an emergency physician at Singapore General Hospital (SGH), Dr. Shen Yuzeng has seen firsthand the struggles of managing a busy, congested emergency department (ED). In our recent HealthTech Fellowship Buildathon, Dr. Shen and his team (consisting of OGP engineers and a designer) developed tED, an app designed to reduce wait times for ED patients. In this Q&A, Dr. Shen shares his insights on the development process, the pilot test, and what’s next for tED.
- Can you share with us more about your profession?
Dr. Shen: I work as an emergency physician at Singapore General Hospital (SGH). Everything is irregular at the emergency department — shift hours, sleep cycles, patient load, patient conditions, etc. Besides clinical work, I’ve done a fair bit of quality improvement work over the years and have grown to appreciate the importance of well-run operations in healthcare and technology solutions as a key enabler. I hold a concurrent appointment as one of the Deputy Chief Medical Informatics Officers (CMIO) at SGH, which has allowed me to broaden my insights and better appreciate nuances at a systems level.
2. As a medical professional on the ground, what inspired you to work on this problem for the Buildathon?
Dr. Shen: The problem we wanted to solve was the long waiting time for patients at the ED. Patients in the ED are attended to without prior investigations or a clear diagnosis. When patients are made to wait in line for an extended period, there is always the risk of their condition deteriorating before they have the chance to see a doctor. Expectations and emotions also get heightened with long wait times and may distract staff from what really matters — giving medical care and attention to their patients.
Senior doctors are also often put under a lot of stress. They have to multitask between managing and reviewing patients, supervising junior doctors, and managing the overall state of the queue and department. This is a common phenomenon across EDs around the world, and the desire to change the situation was what pushed me ahead with this project.
3. How did you and your team arrive at the solution?
Dr. Shen: Fortunately, we did not start from zero. The emergency department has tried various methods over the years to address the situation. I also had the benefit of working across multiple EDs with different methods of managing patient flow. The idea for tED was at least a few years old, but the implementation was never fully realised until OGP’s Healthtech Fellowship Buildathon, where the pieces of the puzzle came together.
Prior to the actual buildathon, OGP’s team of engineers and designers and I spent half a day further refining the solution by deciding what was essential vs. nice-to-have, how to optimise for user experience, and a reasonable technical stack to build upon. Within the 48-hour Buildathon, we built tED, an app that fairly distributes patients to doctors with a double-layered priority-based algorithm, and automates queue management for senior doctors, allowing them to spend more time helping patients and junior doctors.
4. How did you work together with the tED team to finish the product in just 48 hours?
Dr. Shen: Having 48 hours to build forced everyone to ask hard questions. The ability to communicate and discuss implementation with the engineers was also key. Just like how code can get refactored and improved over time, discussing what made sense with the engineers helped refactor and simplify tED. The unexpected outcome I experienced was that I found it much easier subsequently to explain the inner workings of tED to end-users and get buy-in. Other factors that enabled tED to be built in 48 hours were the ability to plug in existing OGP pieces (sign-in, ready stack/infrastructure, governance, etc.), UX/UI inputs to keep the team on track, clear prioritisation and delegation of tasks between team members. The biggest factor really was how everyone in the team demonstrated self-initiative and took clear ownership of the project, allowing the team to complete more than what we had planned for initially. The team was THE key piece of the puzzle.
5. It seems like tED was really well received by the doctors at the pilot test! Could you share with us more about the pilot and the responses?
Dr. Shen: We had an actual working solution by the end of the buildathon, which got the tED team really excited. Given that we had around 2 weeks from the end of the buildathon to the final presentation for the fellowship, I decided to ask for a weekend pilot, when the patient load tends to be lower, to validate tED. Those 2 days gave us valuable insights. We saw positive outcomes both qualitatively and quantitatively, compared to baselines. tED also allowed the department to replace a key manual workflow in place for managing ambulatory patients at the ED. There was a strong indication that we had built something with product-market fit.
Coupled with positive feedback from end-users, we managed to squeeze in a second 2-day pilot during the weekday period. Despite being deployed within the same week where almost a quarter of junior doctors were newly rotated into the department, we successfully reduced waiting times for patients and even allowed some junior doctors to end their shifts earlier!
That 2-week period went by really quickly and turned out to be a fantastic ‘on-the-job’ learning experience. Every day was me trying to reach out and explain tED to as many folks who would be using tED during the pilot as possible (these included doctors, nurses, admin, and support staff), engaging stakeholders to get their buy-in, and working with the tED team to iterative optimise the app and fix bugs. I learned quickly about how to gather, prioritise and work on feedback, how to work with the engineers to effectively improve an MVP, and how to pitch an early-stage product. It was hard work, but it felt great to work on a product that solved a real problem and to work with a team of awesome, motivated folks toward a common goal.
6. What’s next for tED?
Dr. Shen: tED had shown good outcomes over the 4-day pilot. During these 4 days, we discovered bugs that need to be squashed and also gathered valuable feedback about how to further optimise tED. Our potential end users are eager to know when tED will be available on the floor again, and we’re planning to conduct more extended pilots to meet this demand.
In the longer term, if tED is conclusively validated, hopefully, we can extend its use across other parts of the healthcare system and figure out how to implement it in a complementary manner to existing workflows and health IT applications. Hopefully, we can see more such efforts to improve the public healthtech space, where we build and iterate fast with a problem-focused approach.
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tED is made possible by
Dr. Shen Yuzeng, Senior Consultant, Dept of Emergency Medicine, SGH
Daryl Chan, OGP Software Engineer
Austin Woon, OGP Software Engineer
Shi Hui Ling, OGP Software Engineer
Lai Jing Yi, OGP Product Designer
