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Marshall DA, Tagimacruz T, Cepoiu-Martin M, Robert J, Ring B, Burston M, Higgins S, Hess M, White J. A Simulation Modelling Study of Referral Distribution Policies in a Centralized Intake System for Surgical Consultation. J Med Syst 2022; 47:4. [PMID: 36585480 DOI: 10.1007/s10916-022-01897-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 12/01/2022] [Indexed: 01/01/2023]
Abstract
Delays beyond recommended wait times, especially for specialist services, are associated with adverse health outcomes. The Alberta Surgical Initiative aims to improve the referral wait time-the time between a referral is received at the central intake to the time a specialist sees the patient. Using the discrete event simulation modelling approach, we evaluated and compared the impact of four referral distribution policies in a central intake system on three system performance measures (number of consultations, referral wait time and surgeon utilization). The model was co-designed with clinicians and clinic staff to represent the flow of patients through the system. We used data from the Facilitated Access to Surgical Treatment (FAST) centralized intake referral program for General Surgery to parameterize the model. Four distribution policies were evaluated - next-available-surgeon, sequential, "blackjack," and "kanban." A sequential distribution of referrals for surgical consultation among the surgeons resulted in the worst performance in terms of the number of consultations, referral wait time and surgeon utilization. The three other distribution policies are comparable in performance. The "next available surgeon" model provided the most efficient and robust model, with approximately 1,000 more consultations, 100 days shorter referral time and a 14% increase in surgeon utilization. Discrete event simulation (DES) modelling can be an effective tool to illustrate and communicate the impact of the referral distribution policy on system performance in terms of the number of consultations, referral wait time and surgeon utilization.
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Affiliation(s)
- Deborah A Marshall
- Cumming School of Medicine, McCaig Bone and Joint Health Institute, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z, Canada.
| | - Toni Tagimacruz
- Cumming School of Medicine, McCaig Bone and Joint Health Institute, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z, Canada
| | - Monica Cepoiu-Martin
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Jill Robert
- Surgery, Alberta Health Services, Bone & Joint Strategic Clinical NetworkTM, Alberta, Canada
| | - Bernice Ring
- Surgery Strategic Clinical NetworkTM, Alberta Health Services, Alberta, Canada
| | | | - Suzanne Higgins
- Surgery Strategic Clinical NetworkTM, Alberta Health Services, Alberta, Canada
| | | | - Jonathan White
- Surgery Strategic Clinical NetworkTM, Alberta Health Services, Alberta, Canada
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Lopatina E, Damani Z, Bohm E, Noseworthy TW, Conner-Spady B, MacKean G, Simpson CS, Marshall DA. Single-entry models (SEMs) for scheduled services: Towards a roadmap for the implementation of recommended practices. Health Policy 2017; 121:963-970. [PMID: 28830624 DOI: 10.1016/j.healthpol.2017.08.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 07/31/2017] [Accepted: 08/03/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Long waiting times for elective services continue to be a challenging issue. Single-entry models (SEMs) are used to increase access to and flow through the healthcare system. This paper provides a roadmap for healthcare decision-makers, managers, physicians, and researchers to guide implementation and management of successful and sustainable SEMs. METHODS The roadmap was informed by an inductive qualitative synthesis of the findings from a deliberative process (a symposium on SEMs, with clinicians, researchers, senior policy-makers, healthcare managers, and patient representatives) and focus groups with the symposium participants. RESULTS SEMs are a promising strategy to improve the management of referrals and represent one approach to reduce waiting times. The SEMs roadmap outlines current knowledge about SEMs and critical success factors for SEMs' implementation and management. CONCLUSIONS This SEM roadmap is intended to help clinicians, decision-makers, managers, and researchers interested in developing new or strengthening existing SEMs. We consider this roadmap to be a living document that will continue to evolve as we learn more about implementing and managing sustainable SEMs.
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Affiliation(s)
- Elena Lopatina
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Health Research Innovation Centre (HRIC), 3C60, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6, Canada.
| | - Zaheed Damani
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Teaching, Research and Wellness (TRW) building, 3rd floor, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6, Canada.
| | - Eric Bohm
- Concordia Joint Replacement Group, University of Manitoba, 1155 Concordia Ave, Winnipeg, MB, R2K 4L5, Canada.
| | - Tom W Noseworthy
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Teaching, Research and Wellness (TRW) building, 3D14B, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6, Canada.
| | - Barbara Conner-Spady
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Teaching, Research and Wellness (TRW) building, 3rd floor, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6, Canada.
| | - Gail MacKean
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Teaching, Research and Wellness (TRW) building, 3rd floor, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6, Canada.
| | - Chris S Simpson
- Division of Cardiology, Department of Medicine, Queen's University; and, Cardiac Programs, Kingston General Hospital and Hotel Dieu Hospital, 166 Brock Street, Kingston, ON, K7L 5G2, Canada.
| | - Deborah A Marshall
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary; Alberta Bone & Joint Health Institute; and, McCaig Institute for Bone and Joint Health, Health Research Innovation Centre (HRIC), 3C58, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6, Canada.
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Wittmeier KDM, Restall G, Mulder K, Dufault B, Paterson M, Thiessen M, Lix LM. Central intake to improve access to physiotherapy for children with complex needs: a mixed methods case report. BMC Health Serv Res 2016; 16:455. [PMID: 27578196 PMCID: PMC5006453 DOI: 10.1186/s12913-016-1700-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Accepted: 08/23/2016] [Indexed: 12/01/2022] Open
Abstract
Background Children with complex needs can face barriers to system access and navigation related to their need for multiple services and healthcare providers. Central intake for pediatric rehabilitation was developed and implemented in 2008 in Winnipeg Manitoba Canada as a means to enhance service coordination and access for children and their families. This study evaluates the process and impact of implementing a central intake system, using pediatric physiotherapy as a case example. Methods A mixed methods instrumental case study design was used. Interviews were completed with 9 individuals. Data was transcribed and analyzed for themes. Quantitative data (wait times, referral volume and caregiver satisfaction) was collected for children referred to physiotherapy with complex needs (n = 1399), and a comparison group of children referred for orthopedic concerns (n = 3901). Wait times were analyzed using the Kruskal-Wallis test, caregiver satisfaction was analyzed using Fisher exact test and change point modeling was applied to examine referral volume over the study period. Results Interview participants described central intake implementation as creating more streamlined processes. Factors that facilitated successful implementation included 1) agreement among stakeholders, 2) hiring of a central intake coordinator, 3) a financial commitment from the government and 4) leadership at the individual and organization level. Mean (sd) wait times improved for children with complex needs (12.3(13.1) to 8.0(6.9) days from referral to contact with family, p < 0.0001; 29.8(17.9) to 24.3(17.0) days from referral to appointment, p < 0.0001) while referral volumes remained consistent. A small but significant increase in wait times was observed for the comparison group (9.6(8.6) to 10.1(6.6) days from referral to contact with family, p < 0.001; 20.4(14.3) to 22.1(13.1) days from referral to appointment, p < 0.0001), accompanied by an increasing referral volume for this group. Caregiver satisfaction remained high throughout the process (p = 0.48). Conclusions Central intake implementation achieved the intended outcomes of streamlining processes and improving transparency and access to pediatric physiotherapy (i.e., decreasing wait times) for families of children with complex needs. Future research is needed to build on this single discipline case study approach to examine changes in wait times, therapy coordination and stakeholder satisfaction within the context of continuing improvements for pediatric therapy services within the province. Electronic supplementary material The online version of this article (doi:10.1186/s12913-016-1700-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kristy D M Wittmeier
- George and Fay Yee Centre for Healthcare Innovation, 375-753 McDermot Avenue, Winnipeg, MB, R3E 0T6, Canada. .,Department of Pediatrics and Child Health, Rady Faculty of Health Sciences, Health Sciences Centre, University of Manitoba, CE208-840 Sherbrook St., Winnipeg, MB, R3A 1S1, Canada. .,Physiotherapy, Health Sciences Centre, CH246-840 Sherbrook St., Winnipeg, MB, R3A 1S1, Canada.
| | - Gayle Restall
- Department of Occupational Therapy, College of Rehabilitation Sciences, Rady Faculty of Health Sciences, University of Manitoba, R106-771 McDermot Ave, Winnipeg, MB, R3E 0T6, Canada
| | - Kathy Mulder
- Physiotherapy, Health Sciences Centre, CH246-840 Sherbrook St., Winnipeg, MB, R3A 1S1, Canada
| | - Brenden Dufault
- George and Fay Yee Centre for Healthcare Innovation, 375-753 McDermot Avenue, Winnipeg, MB, R3E 0T6, Canada
| | - Marie Paterson
- Physiotherapy, Health Sciences Centre, CH246-840 Sherbrook St., Winnipeg, MB, R3A 1S1, Canada
| | - Matthew Thiessen
- Physiotherapy, Health Sciences Centre, CH246-840 Sherbrook St., Winnipeg, MB, R3A 1S1, Canada
| | - Lisa M Lix
- Department of Community Health Sciences, Rady Faculty of Health Sciences, S113-750 Bannatyne Avenue, Winnipeg, MB, R3E OW6, Canada
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