A model of access combining triage with initial management reduced waiting time for community outpatient services: a stepped wedge cluster randomised controlled trial
Abstract Background Long waiting times are associated with public community outpatient health services. This trial aimed to determine if a new model of care based on evidence-based strategies that improved patient flow in two small pilot trials could be used to reduce waiting time across a variety o...
| Main Authors: | , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2018-10-01
|
| Series: | BMC Medicine |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12916-018-1170-z |
| _version_ | 1818510159546155008 |
|---|---|
| author | Katherine E. Harding Sandra G. Leggat Jennifer J. Watts Bridie Kent Luke Prendergast Michelle Kotis Mary O’Reilly Leila Karimi Annie K. Lewis David A. Snowdon Nicholas F. Taylor |
| author_facet | Katherine E. Harding Sandra G. Leggat Jennifer J. Watts Bridie Kent Luke Prendergast Michelle Kotis Mary O’Reilly Leila Karimi Annie K. Lewis David A. Snowdon Nicholas F. Taylor |
| author_sort | Katherine E. Harding |
| collection | DOAJ |
| description | Abstract Background Long waiting times are associated with public community outpatient health services. This trial aimed to determine if a new model of care based on evidence-based strategies that improved patient flow in two small pilot trials could be used to reduce waiting time across a variety of services. The key principle of the Specific Timely Appointments for Triage (STAT) model is that patients are booked directly into protected assessment appointments and triage is combined with initial management as an alternative to a waiting list and triage system. Methods A stepped wedge cluster randomised controlled trial was conducted between October 2015 and March 2017, involving 3116 patients at eight sites across a major Australian metropolitan health network. Results The intervention reduced waiting time to first appointment by 33.8% (IRR = 0.663, 95% CI 0.516 to 0.852, P = 0.001). Median waiting time decreased from a median of 42 days (IQR 19 to 86) in the control period to a median of 24 days (IQR 13 to 48) in the intervention period. A substantial reduction in variability was also noted. The model did not impact on most secondary outcomes, including time to second appointment, likelihood of discharge by 12 weeks and number of appointments provided, but was associated with a small increase in the rate of missed appointments. Conclusions Broad-scale implementation of a model of access and triage that combined triage with initial management and actively managed the relationship between supply and demand achieved substantial reductions in waiting time without adversely impacting on other aspects of care. The reductions in waiting time are likely to have been driven, primarily, by substantial reductions for those patients previously considered low priority. Trial registration Australian New Zealand Clinical Trials Registry ACTRN12615001016527 registration date: 29/09/2015. |
| first_indexed | 2024-12-10T22:55:23Z |
| format | Article |
| id | doaj.art-536d76a6c7e34765b723bc164743ca7a |
| institution | Directory Open Access Journal |
| issn | 1741-7015 |
| language | English |
| last_indexed | 2024-12-10T22:55:23Z |
| publishDate | 2018-10-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Medicine |
| spelling | doaj.art-536d76a6c7e34765b723bc164743ca7a2022-12-22T01:30:17ZengBMCBMC Medicine1741-70152018-10-0116111010.1186/s12916-018-1170-zA model of access combining triage with initial management reduced waiting time for community outpatient services: a stepped wedge cluster randomised controlled trialKatherine E. Harding0Sandra G. Leggat1Jennifer J. Watts2Bridie Kent3Luke Prendergast4Michelle Kotis5Mary O’Reilly6Leila Karimi7Annie K. Lewis8David A. Snowdon9Nicholas F. Taylor10Eastern HealthLa Trobe UniversityDeakin UniversityUniversity of PlymouthLa Trobe UniversityVictorian Department of Health and Human ServicesEastern HealthLa Trobe UniversityEastern HealthEastern HealthEastern HealthAbstract Background Long waiting times are associated with public community outpatient health services. This trial aimed to determine if a new model of care based on evidence-based strategies that improved patient flow in two small pilot trials could be used to reduce waiting time across a variety of services. The key principle of the Specific Timely Appointments for Triage (STAT) model is that patients are booked directly into protected assessment appointments and triage is combined with initial management as an alternative to a waiting list and triage system. Methods A stepped wedge cluster randomised controlled trial was conducted between October 2015 and March 2017, involving 3116 patients at eight sites across a major Australian metropolitan health network. Results The intervention reduced waiting time to first appointment by 33.8% (IRR = 0.663, 95% CI 0.516 to 0.852, P = 0.001). Median waiting time decreased from a median of 42 days (IQR 19 to 86) in the control period to a median of 24 days (IQR 13 to 48) in the intervention period. A substantial reduction in variability was also noted. The model did not impact on most secondary outcomes, including time to second appointment, likelihood of discharge by 12 weeks and number of appointments provided, but was associated with a small increase in the rate of missed appointments. Conclusions Broad-scale implementation of a model of access and triage that combined triage with initial management and actively managed the relationship between supply and demand achieved substantial reductions in waiting time without adversely impacting on other aspects of care. The reductions in waiting time are likely to have been driven, primarily, by substantial reductions for those patients previously considered low priority. Trial registration Australian New Zealand Clinical Trials Registry ACTRN12615001016527 registration date: 29/09/2015.http://link.springer.com/article/10.1186/s12916-018-1170-zWaiting listsAccessAppointments and schedulesOutpatientsCommunity health |
| spellingShingle | Katherine E. Harding Sandra G. Leggat Jennifer J. Watts Bridie Kent Luke Prendergast Michelle Kotis Mary O’Reilly Leila Karimi Annie K. Lewis David A. Snowdon Nicholas F. Taylor A model of access combining triage with initial management reduced waiting time for community outpatient services: a stepped wedge cluster randomised controlled trial BMC Medicine Waiting lists Access Appointments and schedules Outpatients Community health |
| title | A model of access combining triage with initial management reduced waiting time for community outpatient services: a stepped wedge cluster randomised controlled trial |
| title_full | A model of access combining triage with initial management reduced waiting time for community outpatient services: a stepped wedge cluster randomised controlled trial |
| title_fullStr | A model of access combining triage with initial management reduced waiting time for community outpatient services: a stepped wedge cluster randomised controlled trial |
| title_full_unstemmed | A model of access combining triage with initial management reduced waiting time for community outpatient services: a stepped wedge cluster randomised controlled trial |
| title_short | A model of access combining triage with initial management reduced waiting time for community outpatient services: a stepped wedge cluster randomised controlled trial |
| title_sort | model of access combining triage with initial management reduced waiting time for community outpatient services a stepped wedge cluster randomised controlled trial |
| topic | Waiting lists Access Appointments and schedules Outpatients Community health |
| url | http://link.springer.com/article/10.1186/s12916-018-1170-z |
| work_keys_str_mv | AT katherineeharding amodelofaccesscombiningtriagewithinitialmanagementreducedwaitingtimeforcommunityoutpatientservicesasteppedwedgeclusterrandomisedcontrolledtrial AT sandragleggat amodelofaccesscombiningtriagewithinitialmanagementreducedwaitingtimeforcommunityoutpatientservicesasteppedwedgeclusterrandomisedcontrolledtrial AT jenniferjwatts amodelofaccesscombiningtriagewithinitialmanagementreducedwaitingtimeforcommunityoutpatientservicesasteppedwedgeclusterrandomisedcontrolledtrial AT bridiekent amodelofaccesscombiningtriagewithinitialmanagementreducedwaitingtimeforcommunityoutpatientservicesasteppedwedgeclusterrandomisedcontrolledtrial AT lukeprendergast amodelofaccesscombiningtriagewithinitialmanagementreducedwaitingtimeforcommunityoutpatientservicesasteppedwedgeclusterrandomisedcontrolledtrial AT michellekotis amodelofaccesscombiningtriagewithinitialmanagementreducedwaitingtimeforcommunityoutpatientservicesasteppedwedgeclusterrandomisedcontrolledtrial AT maryoreilly amodelofaccesscombiningtriagewithinitialmanagementreducedwaitingtimeforcommunityoutpatientservicesasteppedwedgeclusterrandomisedcontrolledtrial AT leilakarimi amodelofaccesscombiningtriagewithinitialmanagementreducedwaitingtimeforcommunityoutpatientservicesasteppedwedgeclusterrandomisedcontrolledtrial AT annieklewis amodelofaccesscombiningtriagewithinitialmanagementreducedwaitingtimeforcommunityoutpatientservicesasteppedwedgeclusterrandomisedcontrolledtrial AT davidasnowdon amodelofaccesscombiningtriagewithinitialmanagementreducedwaitingtimeforcommunityoutpatientservicesasteppedwedgeclusterrandomisedcontrolledtrial AT nicholasftaylor amodelofaccesscombiningtriagewithinitialmanagementreducedwaitingtimeforcommunityoutpatientservicesasteppedwedgeclusterrandomisedcontrolledtrial AT katherineeharding modelofaccesscombiningtriagewithinitialmanagementreducedwaitingtimeforcommunityoutpatientservicesasteppedwedgeclusterrandomisedcontrolledtrial AT sandragleggat modelofaccesscombiningtriagewithinitialmanagementreducedwaitingtimeforcommunityoutpatientservicesasteppedwedgeclusterrandomisedcontrolledtrial AT jenniferjwatts modelofaccesscombiningtriagewithinitialmanagementreducedwaitingtimeforcommunityoutpatientservicesasteppedwedgeclusterrandomisedcontrolledtrial AT bridiekent modelofaccesscombiningtriagewithinitialmanagementreducedwaitingtimeforcommunityoutpatientservicesasteppedwedgeclusterrandomisedcontrolledtrial AT lukeprendergast modelofaccesscombiningtriagewithinitialmanagementreducedwaitingtimeforcommunityoutpatientservicesasteppedwedgeclusterrandomisedcontrolledtrial AT michellekotis modelofaccesscombiningtriagewithinitialmanagementreducedwaitingtimeforcommunityoutpatientservicesasteppedwedgeclusterrandomisedcontrolledtrial AT maryoreilly modelofaccesscombiningtriagewithinitialmanagementreducedwaitingtimeforcommunityoutpatientservicesasteppedwedgeclusterrandomisedcontrolledtrial AT leilakarimi modelofaccesscombiningtriagewithinitialmanagementreducedwaitingtimeforcommunityoutpatientservicesasteppedwedgeclusterrandomisedcontrolledtrial AT annieklewis modelofaccesscombiningtriagewithinitialmanagementreducedwaitingtimeforcommunityoutpatientservicesasteppedwedgeclusterrandomisedcontrolledtrial AT davidasnowdon modelofaccesscombiningtriagewithinitialmanagementreducedwaitingtimeforcommunityoutpatientservicesasteppedwedgeclusterrandomisedcontrolledtrial AT nicholasftaylor modelofaccesscombiningtriagewithinitialmanagementreducedwaitingtimeforcommunityoutpatientservicesasteppedwedgeclusterrandomisedcontrolledtrial |