Cardiac EASE (Ensuring Access and Speedy Evaluation) - the impact of a single-point-of-entry multidisciplinary outpatient cardiology consultation program on wait times in Canada

Abstract

Background: Universal access to health care is valued in Canada but increasing wait times for services (eg, cardiology consultation) raise safety questions. Observations suggest that deficiencies in the process of care contribute to wait times. Consequently, an outpatient clinic was designed for Ensuring Access and Speedy Evaluation (Cardiac EASE) in a university group practice, providing cardiac consultative services for northern Alberta. Cardiac EASE has two components: a single-point-ofentry intake service (prospective testing using physician-approved algorithms and previsit triage) and a multidisciplinary clinic (staffed by cardiologists, nurse practitioners and doctoral-trained pharmacists).

Objectives: It was hypothesized that Cardiac EASE would reduce the time to initial consultation and a definitive diagnosis, and also increase the referral capacity.

Methods: The primary and secondary outcomes were time from referral to initial consultation, and time to achieve a definitive diagnosis and management plan, respectively. A conventionally managed historical control group (three-month pre-EASE period in 2003) was compared with the EASE group (2004 to 2006). The conventional referral mechanism continued concurrently with EASE.

Results: A comparison between pre-EASE (n=311) and EASE (n=3096) revealed no difference in the mean (+/- SD) age (60+/-16 years), sex (55% and 52% men, respectively) or reason for referral, including chest pain (31% and 40%, respectively) and arrhythmia (27% and 29%, respectively). Cardiac EASE reduced the time to initial cardiac consultation (from 71+/-45 days to 33+/-19 days) and time to a definitive diagnosis (from 120+/-86 days to 51+/-58 days) (P<0.0001). The annual number of new referrals increased from 1512 in 2002 to 2574 in 2006 due to growth in the Cardiac EASE clinic. The number of patients seen through the conventional referral mechanism and their wait times remained constant during the study period.

Conclusions: Cardiac EASE reduced wait times, increased capacity and shortened time to achieve a diagnosis. The EASE model could shorten wait times for consultative services in Canada.

Figure 1)

The increasing number of patients seen in Cardiac EASE (Ensuring Access and Speedy Evaluation) over time. Note the increase in new referrals via the EASE mechanism was due to ‘new capacity’. Cardiac EASE added to and did not decrease new referrals seen by the conventional mechanism

Figure 2)

Wait times for initial consultation decreased during Cardiac EASE (Ensuring Access and Speedy Evaluation)

Figure 3)

Time to initial consultation increased during Cardiac EASE (Ensuring Access and Speedy Evaluation) but remained shorter than in the conventional track. Despite the increase in wait times within EASE in 2006, wait times remained substantially shorter than in patients seen through the conventional mechanism. Data for wait times in the conventional pathway were not available for 2004 because of a change in the office medical record billing system during that year

Figure 4)

Time to definitive diagnosis or disposition decreased during Cardiac EASE (Ensuring Access and Speedy Evaluation)