Specific timely appointments for triage to reduce wait times in a medical outpatient clinic: protocol of a pre-post study with process evaluation

Abstract

BackgroundManaging demand for services is a problem in many areas of healthcare, including specialist medical outpatient clinics. Some of these clinics have long waiting lists with variation in access for referred people. A model of triage and appointment allocation has been developed and tested that has reduced waiting times by about a third in community outpatient services. This study aims to determine whether the model can be applied in the setting of a specialist medical outpatient clinic to reduce wait time from referral to first appointment.MethodsA pre-post study will collect data before and after implementing the Specific Timely Appointments for Triage (STAT) model of access and triage. The study will incorporate a pre-implementation period of 12 months, an implementation period of up to 6 months and a post STAT-implementation period of 6 months. The setting will be the epilepsy clinic at a metropolitan health service in Melbourne. Included will be all people referred to the clinic, or currently waiting, during the allocated periods of data collection (total sample estimated n = 975). Data routinely collected by the health service and qualitative data from staff will be analysed to determine the effects of introducing the STAT model. The primary outcome will be wait time, measured by number of patients on the wait list at monthly time points and the mean number of days waited from referral to first appointment. Secondary outcomes will include patient outcomes, such as admission to hospital while waiting, and service outcomes, including rate of discharge. Analysis of the primary outcome will include interrupted time series analysis and simple comparisons of the pre and post-implementation periods. Process evaluation will include investigation of the fidelity of the intervention, adaptations required and qualitative analysis of the experiences of clinic staff.DiscussionPrompt access to service and optimum patient flow is important for patients and service providers. Testing the STAT model in a specialist medical outpatient clinic will add to the evidence informing service providers and policy makers about how the active management of supply and demand in health care can influence wait times. The results from this study may be applicable to other specialist medical outpatient clinics, potentially improving access to care for many people.

Perceived barriers to the uptake of health services among first-year university students in Johannesburg, South Africa

“…Potential solutions such as streamlining clinic flow/processes and improved provider-patient communication (e.g., use of signposts) to direct clients to correct queues and improve client satisfaction when there are staff shortages should be considered to reduce waiting time [ 35 ]. Campus health services could potentially address this barrier and, together with a model of appointment allocation, reduce waiting times and the negative impact of care-seeking on students’ studies [ 36 ].…”

Specialist wait time reporting using family physicians’ electronic medical record data: a mixed method study of feasibility and clinical utility

“…This could complement other initiatives that may contribute to shortening specialist wait times including telehealth consults [ 22 ] (electronic asynchronous consultations obviating the need for face to face appointments between patient and specialist) and e-referral systems (i.e. province wide electronic health referral system where wait times could be viewed and referral status could be tracked), pre-assessment in specialized clinics [ 23 ] (a model of triage and appointment allocation to reduce wait times), and central intake [ 24 ] (instead of having multiple-queues and multiple-servers to manage referrals, specific specialists in a given jurisdiction would have a single queue allowing each patient to see the first available specialist) [ 25 , 26 ]. In 2008, the Edmonton North Primary Care Network (PCN) developed a provincial e-referral system, which includes a specialist database with information on specialist referral requirements, forms and protocols, and tracks wait times [ 27 ].…”

Reducing the waitlist of referred patients in a medical specialist outpatient clinic: an observational study

“…It is acknowledged that this study has effectively reduced a significantly large and long waitlist, but that this is of little worth unless it is sustained and embedded to implement the governing policy objective – to provide equitable and timely access to the epilepsy clinic. This observational study achieved its aim and places the epilepsy clinic in readiness to implement the next phase of the STAT model, which aims to achieve sustained reductions in waiting time after reducing or eliminating the waitlist (Lewis et al , 2019). The next part of this research will tackle the continued integration of changed behaviour, administration and management of demand for the service.…”

“…The design is an observational study of the localised impact of the reduction of a waitlist in an epilepsy clinic. This was conducted as a component of a broader study evaluating an intervention to reduce wait time from referral to first appointment (Lewis et al , 2019). Ethical approval was provided by the health service and university Human Research Ethics Committees, reference number LR19/014.…”