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QI initiatives, centralized triage improve wait times for priority patients
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Quality improvement initiatives and centralized triage of rheumatology referrals were effective in improving wait times for priority patients at a hospital in Canada, according to recent findings published in The Journal of Rheumatology.
“Given the prevalence of rheumatologic disease, the limited number of rheumatologists in Canada, and the call to improve wait times for initial assessment and treatment of disease, a variety of solutions have been proposed to meet the needs of Canadians,” Chandra Farrer, BScPT, clinical lecturer in the department of physical therapy at the University of Toronto, and colleagues wrote. “These include maximization of health care staff, improving practice efficiencies, improving quality of referral letters and centralized triage systems.”
Wait-time benchmarks for inflammatory arthritis (IA) and connective tissue disease (CTD) were published by the Canadian Rheumatology Association in 2014, the researchers wrote.
Farrer and colleagues assessed whether quality improvement (QI) initiatives, including priority referral assignment, booking templates and monthly audits, as well as centralized triage, would improve wait times for priority rheumatology patients.
In the study, an advanced practice physiotherapist compared rheumatology referrals retrospectively triaged from September to November 2012 (n = 227) with referrals triaged from January to March 2014 (n = 331). The physiotherapist assigned a priority ranking to each referral and categorized it as suspected IA/CTD or suspected non-IA/CTD. Afterward, researchers assessed the time to initial consult and the time from referral to appointment notification.
The researchers evaluated 558 referrals with 35 exclusions. In 2012, 42.5% of patients had suspected IA/CTD at time of initial consult, with an average wait time of 33.8 days (95% CI, 27.8-39.8) and 54.9% had suspected non-IA/CTD, with an average wait time of 37.3 days (95% CI, 32.9-41.7). In 2014, 43% of patients had suspected IA based on the referral letter, with an average wait time of 15.5 days (95% CI, 13.85-17.15). Those with suspected non-IA had an average wait time of 52.2 days (95% CI, 46.3-58.1). Overall, the time to appointment notification improved from 17 days to 4.37 days.
The researchers concluded that the combination of QI initiatives and centralized triage were effective in improving wait times.
“The addition of centralized triage and [QI] measures including booking templates, monthly audits, and the implementation of wait-time benchmarks led to significant reductions of wait times for patients suspected of having IA or CTD,” the researchers wrote. “Future research is needed to assess the individual effect of each of the strategies.” – by Will Offit
Disclosure: Healio.com/Rheumatology could not confirm relevant financial disclosures at time of publication.
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