Examining the Association Between Referral Quality, Wait Time and Patient Outcomes for Patients Referred to an IBD Specialty Program

Abstract

<jats:title>Abstract</jats:title> <jats:sec> <jats:title>Background</jats:title> <jats:p>Most speciality inflammatory bowel disease (IBD) care can only be accessed through a referral. Timely access to specialty care has been associated with improved disease-related outcomes. To receive appropriate care, the referral needs to include high-quality information. To date, no research has explored the association between referral quality and IBD patient outcomes. The study objectives were to determine if the quality of referrals to a collaborative IBD program influenced triage accuracy, wait times and patient outcomes.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>Two hundred referrals to a collaborative IBD program in Canada for patients with confirmed or suspected IBD were reviewed. Referral quality was evaluated using an evidence- and consensus-based metric. The association between referral quality and patient outcomes (wait time, hospitalizations, disease flares and additional referrals) for semi-urgent referrals was assessed through multivariate analysis.</jats:p> </jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>The majority of referrals for IBD speciality care were categorized as being low quality. Referral quality was not significantly associated with any of the patient outcomes; however, longer wait times significantly increased the occurrence of disease flares, hospitalizations and additional referrals while waiting for an IBD specialist appointment.</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusion</jats:title> <jats:p>Prolonged wait times for IBD patients are significantly associated with poor patient outcomes and increased costs for the health care system. Although there is literature that suggests that referral quality may be associated with wait time, it is still unclear how it relates to wait time and patient outcomes. Moving forward, the current referral process needs to be critically addressed in order to improve wait times and patient outcomes.</jats:p> </jats:sec>

Audit of enuresis referrals on the waiting list for a tertiary hospital outpatient clinic

“…8,18 Our audit did not explore factors contributing to delays, but did reveal that over half of referrals were inadequate in terms of temporal and disease stratification. The inconsistency of referral quality is substantiated in the literature 16 and may contribute to delays with prioritisation and triage. Strategies aimed at improving the delivery of care and improved patient outcomes have been discussed in the literature such as referral initiatives, resource alignment, operational efficiency and process improvement.…”

“…For enuresis, detailed information could help redirect the patient to a more appropriate clinic and decrease wait time to treatment. The importance of timely care is supported by a Canadian study that revealed increasing waiting times were associated with disease flares, hospitalisations and additional referrals for patients with inflammatory bowel disease 16 . They also highlighted the shortfalls of referrals, where 20% of referrals did not include the diagnosis, 45% did not report the duration and 29% did not report severity 16 .…”

“…The importance of timely care is supported by a Canadian study that revealed increasing waiting times were associated with disease flares, hospitalisations and additional referrals for patients with inflammatory bowel disease. 16 They also highlighted the shortfalls of referrals, where 20% of referrals did not include the diagnosis, 45% did not report the duration and 29% did not report severity. 16 Thus, suggesting a link between wait time, referral quality and poor patient outcomes.…”

“…16 They also highlighted the shortfalls of referrals, where 20% of referrals did not include the diagnosis, 45% did not report the duration and 29% did not report severity. 16 Thus, suggesting a link between wait time, referral quality and poor patient outcomes.…”

Review of referrals reveal the impact of referral content on the triage and management of ophthalmology wait lists

“…24 Additionally, patients who are referred with incomplete referrals can experience longer wait times than those referred with more complete referrals as they may be perceived as less urgent. 25 Lengthy wait lists can also cause the content of interminably queued referrals to become outdated. 6 Referral quality may differ depending on the referrer’s profession 8 and referral format, 26 and standardised referral templates can mitigate such issues.…”