This article is more than 5 years old. Information may no longer be current.
Centralized intake system, nurse triage improved wait times, efficiency in rheumatology clinic
Referral quality and system efficiencies were improved and wait times were reduced under a centralized intake system and managed triage of rheumatology referrals with trained nurses, according to researchers in Calgary, Canada.
Researchers introduced the Central Referral and Triage in Rheumatology system to a rheumatology center in Calgary. A referral system was established by directing all referrals through a single fax number and creating a service hub in the central referral and triage office. Specialized clinics were designed to expedite care of patients who required urgent care.
A nurse with 15 years of experience in rheumatology conducted triage, and two clerical support personnel processed referrals and interacted with the referring physicians. Two senior rheumatologists who were designated as expert reviewers addressed concerns identified by the nurse. A multi-user database was used to track referrals. Referrals were cancelled in the absence of minimum required data after repeated requests for follow-up.
Following triage, the nurse formulated a working diagnosis and categorized the patients’ needs as emergent, urgent, moderate or routine before consulting with one of the rheumatologists. A rheumatologist on-call was contacted for emergent consultations. Other patients were assigned a tentative appointment date with the next available rheumatologist, unless a specific physician was requested. Patients with uncomplicated needs were referred to the nurse practitioner clinic.
Pre- and post-implementation surveys of the rheumatologists were conducted, and the number of referrals, no-shows, duplicate referrals and wait times between the referral and appointment date were calculated at 2 years and at more than 7 years.
Following implementation, the mean wait time to an appointment was similar for patients with routine needs, but improved for patients who required moderate or urgent care. Feedback from rheumatologists who handled 3,779 referrals during a 2-year period showed improvement in referral quality and triage category was deemed appropriate in 90% of 3,665 referrals, with a low rate of misclassification.
During the 7-year period as the population served increased from 1.8 million to 2.2 million, the number of full-time rheumatologists employed remained at a similar number and patient no-shows decreased to less than 2% from 8% at baseline. Target mean wait times for urgent and moderate referrals were met in most years, but wait times for routine referrals increased and did not meet target wait times of 4 months to 8 months. – by Shirley Pulawski
Disclosure: The researchers report no relevant financial disclosures.