Reducing Waiting Times: Using an Opt-In System and Changing Prioritisation Criteria

Going Beyond Waitlists in Mental Healthcare

Managing waitlists for outpatient mental health services particularly in community health settings is difficult to standardize, poses an administrative burden, and are barriers rather than gateways to access to care particularly for low-income communities. While telehealth has initially expanded access to mental healthcare at the onset of the COVID-19 pandemic, it has not resolved the challenges associated with the increasing demand for services and the shortage of available providers. This commentary explores the intricate interconnections between wait times, readiness for and appropriateness of therapy, and engagement in treatment. Drawing on insights from waiting line theory to question the attachment to and utility of waitlists for non-emergency, outpatient mental healthcare, this commentary questions the utility and efficacy of waitlists. Alternative solutions that capitalize on community resources and collaboration and harness patients' agency for change are discussed.

Service redesign interventions to reduce waiting time for paediatric rehabilitation and therapy services: A systematic review of the literature

Despite well-documented benefits of rehabilitation and therapy services for children with disabilities, long waiting lists to access these services are common. There is a growing body of evidence, primarily from mixed or adult services, demonstrating that waiting times can be reduced through strategies that target wasteful processes and support services to keep up with demand. However, providers of rehabilitation and therapy services for children face additional complexities related to the long-term nature of many developmental conditions and the need to consider timing of interventions with developmental milestones and education transition points. This review aimed to synthesise available evidence on service redesign strategies in reducing waiting time for paediatric therapy services. We conducted a systematic review of studies conducted in outpatient paediatric rehabilitation or therapy settings, including physical and mental health services, evaluating a service redesign intervention and presenting comparative data on time to access care. Two reviewers independently applied inclusion criteria, assessed risk of bias and extracted data. Findings were analysed descriptively and the certainty of evidence was synthesised according to criteria for health service research. From 1934 studies identified, 33 met the criteria for inclusion. Interventions were categorised as rapid response strategies, process efficiency interventions or substitution strategies (using alternative providers in place of medical specialists). Reductions in waiting time were reported in 30 studies. Evidence is limited by study designs with high risk of bias, but this is mitigated by consistency of findings and large effect sizes. There is moderate-certainty evidence that service redesign strategies similar to those used in adult populations can be applied in paediatric rehabilitation and therapy settings to reduce waiting time.

Evaluating a primary care psychology service in Ireland: a survey of stakeholders and psychologists

Primary care psychology services (PCPS) represent an important resource in meeting the various health needs of our communities. This study evaluated the PCPS in a two-county area within the Republic of Ireland. The objectives were to (i) examine the viewpoints of the service for both psychologists and stakeholders (healthcare professionals only) and (ii) examine the enactment of the stepped care model of service provision. Separate surveys were sent to primary care psychologists (n = 8), general practitioners (GPs; n = 69) and other stakeholders in the two counties. GPs and stakeholders were required to rate the current PCPS. The GP survey specifically examined referrals to the PCPS and service configuration, while the stakeholder survey also requested suggestions for future service provision. Psychologists were required to provide information regarding their workload, time spent on certain tasks and productivity ideas. Referral numbers, waiting lists and waiting times were also obtained. All 8 psychologists, 23 GPs (33% response rate) and 37 stakeholders (unknown response rate) responded. GPs and stakeholders reported access to the PCPS as a primary concern, with waiting times of up to 80 weeks in some areas. Service provision to children and adults was uneven between counties. A stepped care model of service provision was not observed. Access can be improved by further implementation of a stepped care service, developing a high-throughput service for adults (based on a stepped care model), and employing a single waiting list for each county to ensure equal access.

A quality improvement project to reduce waiting time for pediatric outpatient referral clinics in Singapore

Background:

The long waiting time in our General Pediatric Clinic results in the delay in diagnosis and treatment leading to increase in morbidity and dissatisfaction rate among sick children who seek treatment at KK Women’s and Children’s Hospital, Singapore. The mean ± SD waiting time in our General Pediatric Clinic increased from 40 ± 4 days in 2008 and 45 ± 7 days in 2009 to 50 ± 5 days in 2010.

Objectives:

To reduce long waiting times in our General Pediatric Clinic by 20%.

Methods:

The Reducing Waiting Time Working Group was formed to tackle the waiting time problem in the General Pediatric Clinic. Extensive literature was searched and reviewed, brainstorming and discussions were carried out and strategies were developed. A series of implementations were carried out sequentially including clearing of the backlog of cases, development of general and fast track referral guidelines, triaging system and ‘5 Days SMS and 48 Hours Call’ system.

Results:

By clearing the backlog cases, waiting time was reduced from 57 days to 44 days. Through effective triaging system and ‘5 Days SMS and 48 Hours Call’ system, the mean ± SD waiting time was further reduced by 30% from 50 ± 5 days to 35 ± 7 days. By June 2012, the mean waiting time was 27 days.

Conclusions:

Waiting time is one of the important indicators of healthcare quality provided by any healthcare institution. Through these implementations, waiting time was successfully reduced by 30%. These methods may serve as viable options to improve waiting time in other healthcare settings.

Do triage systems in healthcare improve patient flow? A systematic review of the literature

OBJECTIVES

Triage processes are often used by Emergency Departments to sort patients according to urgency or type of service required. Triage may also be used in a broad spectrum of other health services and not just emergency departments. Triage systems may be used to ensure the most urgent patients get timely service, but do they have an effect on patient flow?

METHODS

We conducted a systematic review by searching five electronic databases (until August 2009) combining the elements 'triage' and 'patient flow', complemented by hand searching reference lists and citation tracking. We identified and assessed the quality of 25 articles that met inclusion criteria. Population, setting, design and results were extracted and a process of descriptive synthesis applied. Effect sizes for waiting time were compared for seven studies in which sufficient data could be extracted.

RESULTS AND CONCLUSION

Moderate evidence exists from a range of health services that the ability to combine triage and initial treatment in less resource intensive cases can have a positive effect on patient flow. There is conflicting evidence that triage systems that only prioritize patients, without providing any treatment, improve overall patient flow, although tailoring triage criteria more specifically to the patient population or using triage to prioritize treatable cases may be of benefit.