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

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Version 3 2024-06-18, 11:15
Version 2 2024-06-05, 10:31
Version 1 2018-11-27, 10:25
journal contribution
posted on 2024-06-18, 11:15 authored by KE Harding, SG Leggat, Jennifer WattsJennifer Watts, Bridie KentBridie Kent, L Prendergast, M Kotis, M O'Reilly, L Karimi, AK Lewis, DA Snowdon, NF Taylor
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.

History

Journal

BMC Medicine

Volume

16

Article number

ARTN 182

Pagination

1 - 10

Location

England

Open access

  • Yes

ISSN

1741-7015

eISSN

1741-7015

Language

English

Publication classification

C1 Refereed article in a scholarly journal

Copyright notice

2018, The Author(s)

Issue

1

Publisher

BMC