Online referral and immediate appointment selection system empowers families and improves access to public community paediatric clinics

Abstract

Aim We aimed to introduce a low‐cost combined online referral and immediate appointment selection system (CORIAS) to empower referrers and parents by allowing them to schedule an appointment at a time and location of their choosing in conjunction with the referrer at the time of referral. This was because an unacceptably high rate of reported lost referrals, combined with a high rate of failure to attend initial appointments (FTAs), was noted at a six‐site community paediatric clinic service. We aimed to analyse the impact of CORIAS on important outcomes including timely appointment scheduling, attendance, loss of referrals, user acceptance, overall cost and administrative burden. Methods For 3‐month periods before and after the implementation of CORIAS, data were collected regarding all new referrals received and initial appointments scheduled, as well as reports of lost referrals. The number of attended initial appointments, FTAs, failures in successfully scheduling appointments, referrer background, CORIAS cost and qualitative feedback received from relevant parties was collated and analysed. Results The proportion of referrals reported lost was 6% following the implementation of the combined online system in comparison to 17% pre‐implementation. The FTA rate for scheduled initial appointments pre‐implementation was 16%; post‐implementation, the FTA rate was 9%. Qualitative benefits included a decrease in the administrative burden associated with appointment scheduling and increased service access for culturally and linguistically diverse families. Conclusion Appropriately designed and implemented novel online systems may improve timely and equitable access to health care by providing secure, reliable pathways for referrers and by empowering and improving communication with patients and families.

Predictors of Subspecialty Appointment Scheduling and Completion for Patients Referred From a Pediatric Primary Care Clinic

“…Open access scheduling, electronic consultation and referral systems, centralized scheduling systems, and the addition of advanced practitioners or PCPs to subspecialty departments have all been tested with mixed success on referral volume and patient wait times. [43][44][45][46][47][48][49][50][51] Several studies have shown that personalized appointment reminders, as opposed to automated [52][53][54] and longer term relationships with PCPs 25,36 are positively associated with appointment completion, suggesting the importance of personal connectivity and ongoing relationships. However, many of the most challenging barriers for families are problems such as transportation, work schedules, and child care, 35,55 which are difficult for health care organizations to address.…”

Inequitable access: factors associated with incomplete referrals to paediatric cardiology

“…This could be caused by higher parental concern or higher acuity/need for cardiology referral. Implementing a process of online referrals with the ability to make an immediate appointment improves attendance of subspeciality clinic visits [45]. However, blanket implementation of certain interventions, particularly those that involve use of technological innovations, could worsen inequities present in subspecialty access to care [46].…”