Improving access to community and outpatient services
Excessive and inequitable waiting times for care can be a problem for both patients and health services. Access issues are not only associated with emergency departments and surgical procedures; patients seeking sub-acute and community-based services also experience lengthy waiting lists, resulting in poorer health outcomes, anxiety, and reduced engagement with services.
Waiting lists are often considered to be the result of a disparity between demand and supply. Short term strategies, such as temporary increases in supply, often fail to resolve the underlying problem and waiting lists simply recur. In contrast, promising results have been reported from strategies that address patient flow by reducing complexity in booking systems, combining triage with initial management, and/or actively managing the relationship between supply and demand.
We developed a model for access and triage known as Specific Timely Appointments for Triage (STAT) that brings these elements together to try to reduce waiting time for health services. We conducted a stepped wedge cluster randomised controlled trial involving 8 services and 3116 patients, to see whether STAT reduced waiting time without having an adverse impact on other aspects of care. Median time from referral to first appointment reduced from 60 days pre to 36 days post-intervention across all sites (IRR 0.66, 95% CI 0.52 to 0.85) with no change in secondary outcomes, including time to second appointment, unplanned hospital admissions or rate of discharge after 3 months. Variation in waiting time also reduced, suggesting improvement in equity of access to services.
This study demonstrates that waiting times for community and outpatient services are not inevitable. Improvements in access can be achieved by addressing service inefficiencies and encouraging service providers to make priority decisions about service delivery in response to demand.
Harding, K.E., Leggat, S.G., Watts, J.J. et al. A model of access combining triage with initial management reduced waiting time for community outpatient services: a stepped wedge cluster randomised controlled trial. BMC Med 16, 182 (2018) doi:10.1186/s12916-018-1170-z (Publisher site)
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