Time to wait: a systematic review of strategies that affect out-patient waiting times

Abstract

Objective Out-patient waiting times pose a significant challenge for public patients in need of specialist evaluation and intervention. The aim of the present study was to identify and categorise effective strategies to reduce waiting times for specialist out-patient services with a focus on the Australian healthcare system. Methods A systematic review of major health databases was conducted using the key terms 'outpatient*' AND 'waiting time', 'process*' AND 'improvement in outpatient clinics'. Identified articles were assessed for their relevance by sequential review of the title, abstract and full text. References of the selected manuscripts were scanned for additional relevant articles. Selected articles were evaluated for consistent and emerging themes. Results In all, 152 articles were screened, of which 38 were included in the present review. Numerous strategies identified in the articles were consolidated into 26 consistent approaches. Three overarching themes were identified as significantly affecting waiting times: resource realignment, operational efficiency and process improvement. Conclusions Strategies to align resources, increase operational efficiency and improve processes provide a comprehensive approach that may reduce out-patient waiting times. What is known about the topic? Out-patient waiting times are a challenge in most countries that seek to provide universal access to health care for all citizens. Although there has been extensive research in this area, many patients still experience extensive delays accessing specialist care, particularly in the public health sector. The multiple factors that contribute to bottlenecks and inefficiencies in the referral process and affect patient waiting times are often poorly understood. What does this paper add? This paper reviews the published healthcare literature to identify strategies that affect specialist out-patient waiting times for patients. The findings suggest that there are numerous operational strategies that affect waiting times. These strategies may be categorised into three overarching themes (resource alignment, operational efficiencies and out-patient processes) that, when actioned in a coordinated approach, have the potential to significantly reduce out-patient waiting times. What are the implications for practitioners? This paper identifies evidence-based strategies for aligning resources, improving operational efficiency and streamlining processes, which may provide improvements to specialist out-patient waiting times for patients. Addressing the identified organisational, person-related, cultural and attitudinal factors will assist health system managers and health practitioners target the most appropriate improvement activities to reduce waiting times.

Long Waiting Times for Elective Hospital Care – Breaking the Vicious Circle by Abandoning Prioritisation

“…Factors other than capacity, such as patient logistics, complex booking processes, and poor use of resources, might also influence waiting. [15][16][17][18][19][20] There is reason to believe that the policies used for patient appointment allocation in secondary healthcare influence waiting times more than previously assumed.…”

Retrospective audit of referral and triage pathways of paediatric patients with constipation and soiling

“…Several factors may contribute to increased wait times, such as high volumes of incoming referrals, referral management and acceptance parameters, triage and scheduling procedures and prioritisation based on severity. 21 The importance of timely management for this cohort cannot be overestimated, where delays in management may result in patients suffering from psychological and social complications arising from their condition. For families experiencing disadvantage, the need for timely and low-cost care in the public setting is important to ensure that all children receive quality care and that socio-economic disparities do not impact child outcomes.…”

“…However, the most significant obstacle in the provision of timely management for constipation, a relatively low morbidity chronic condition, is wait time. Several factors may contribute to increased wait times, such as high volumes of incoming referrals, referral management and acceptance parameters, triage and scheduling procedures and prioritisation based on severity …”

Paediatric bladder dysfunction: A single centre experience of public hospital wait times

“…In large settings, such as hospitals, implementation of quality improvement initiatives are labour‐intensive and likely to be influenced by economic, social, and hospital policy‐driven barriers. There are usually several strategies that may be applied to improve the delivery of care and achieve better patient outcomes . As shown in this study, one of the first steps is an audit of current practice and process maps to identify areas where potential quality improvement initiatives can be applied.…”

“…This information is particularly important for common low‐morbidity childhood conditions such as wetting, where access to alarm therapy in the community is challenging. The large number of children referred to tertiary care has been suggested to result in longer waiting times, which may lead to deterioration in both symptoms and QoL . Existing methods for managing access and triage to outpatient services may lead to inequities in service delivery, inefficiencies, and divert resources from community‐based care.…”