A model of access combining triage with initial management reduced waiting time for community outpatient services: a stepped wedge cluster randomised controlled trial

Harding, Katherine E, Leggat, Sandra G, Watts, Jennifer J, Kent, Bridie, Prendergast, Luke, Kotis, Michelle, O'Reilly, Mary, Karimi, Leila, Lewis, Annie K, Snowdon, David A and Taylor, Nicholas F 2018, 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, vol. 16, pp. 1-10, doi: 10.1186/s12916-018-1170-z.

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Title A model of access combining triage with initial management reduced waiting time for community outpatient services: a stepped wedge cluster randomised controlled trial
Author(s) Harding, Katherine E
Leggat, Sandra G
Watts, Jennifer JORCID iD for Watts, Jennifer J orcid.org/0000-0001-8095-8638
Kent, Bridie
Prendergast, Luke
Kotis, Michelle
O'Reilly, Mary
Karimi, Leila
Lewis, Annie K
Snowdon, David A
Taylor, Nicholas F
Journal name BMC medicine
Volume number 16
Article ID 182
Start page 1
End page 10
Total pages 10
Publisher BioMed Central
Place of publication London, Eng.
Publication date 2018-10-19
ISSN 1741-7015
Keyword(s) waiting lists
access
appointments and schedules
outpatients
community health
ambulatory care
Australia
triage
science & technology
life sciences & biomedicine
medicine, general & internal
general & internal medicine
Summary 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.
Language eng
DOI 10.1186/s12916-018-1170-z
Field of Research 11 Medical And Health Sciences
HERDC Research category C1 Refereed article in a scholarly journal
Copyright notice ©2018, The Author(s)
Persistent URL http://hdl.handle.net/10536/DRO/DU:30115660

Document type: Journal Article
Collections: School of Health and Social Development
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