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

doi:10.1186/s12916-018-1170-z

Randomized Controlled Trial

. 2018 Oct 19;16(1):182.

doi: 10.1186/s12916-018-1170-z.

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

Katherine E Harding^{1

2}, Sandra G Leggat³, Jennifer J Watts⁴, Bridie Kent⁵, Luke Prendergast³, Michelle Kotis⁶, Mary O'Reilly⁷, Leila Karimi³, Annie K Lewis^{7

3}, David A Snowdon^{7

3}, Nicholas F Taylor^{7

3}

Affiliations

¹ Eastern Health, Level 2/5 Arnold Street, Box Hill, VIC, 3128, Australia. katherine.harding@easternhealth.org.au.
² La Trobe University, Kingsbury Drive, Bundoora, VIC, 3086, Australia. katherine.harding@easternhealth.org.au.
³ La Trobe University, Kingsbury Drive, Bundoora, VIC, 3086, Australia.
⁴ Deakin University, 221 Burwood Highway, Burwood, VIC, 3125, Australia.
⁵ University of Plymouth, Drake Circus, Plymouth, Devon, PL4 8AA, UK.
⁶ Victorian Department of Health and Human Services, 50 Lonsdale Street, Melbourne, VIC, 3000, Australia.
⁷ Eastern Health, Level 2/5 Arnold Street, Box Hill, VIC, 3128, Australia.

PMID: 30336784
PMCID: PMC6194740
DOI: 10.1186/s12916-018-1170-z

Randomized Controlled Trial

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

Katherine E Harding et al. BMC Med. 2018.

. 2018 Oct 19;16(1):182.

doi: 10.1186/s12916-018-1170-z.

Authors

Affiliations

¹ Eastern Health, Level 2/5 Arnold Street, Box Hill, VIC, 3128, Australia. katherine.harding@easternhealth.org.au.
² La Trobe University, Kingsbury Drive, Bundoora, VIC, 3086, Australia. katherine.harding@easternhealth.org.au.
³ La Trobe University, Kingsbury Drive, Bundoora, VIC, 3086, Australia.
⁴ Deakin University, 221 Burwood Highway, Burwood, VIC, 3125, Australia.
⁵ University of Plymouth, Drake Circus, Plymouth, Devon, PL4 8AA, UK.
⁶ Victorian Department of Health and Human Services, 50 Lonsdale Street, Melbourne, VIC, 3000, Australia.
⁷ Eastern Health, Level 2/5 Arnold Street, Box Hill, VIC, 3128, Australia.

PMID: 30336784
PMCID: PMC6194740
DOI: 10.1186/s12916-018-1170-z

Abstract

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.

Keywords: Access; Appointments and schedules; Community health; Outpatients; Waiting lists.

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Conflict of interest statement

Ethics approval and consent to participate

The trial was approved by the Eastern Health Human Research Ethics Committee (E06-2014). Managers of each site (cluster) provided consent to participate on behalf of their service. A waiver of consent was granted for use of routinely collected health service data.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

**Fig. 1**
Stepped Wedge trial design. *Excludes period from December 25 to end of January in each year of the trial. Light shade denotes control period, the dark shade the implementation period, and medium shade the intervention period

**Fig. 2**
Waiting time for control (left) and intervention (right) periods. Median represented by bar, 25th and 75th percentiles represented by box and upper and lower quartiles represented by whiskers

See this image and copyright information in PMC

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References

1. Rotstein D, Alter D. Where does the waiting list begin? A short review of the dynamics and organization of modern waiting lists. Soc Sci Med. 2006;62:3157–3160. doi: 10.1016/j.socscimed.2005.11.030. - DOI - PubMed
1. Lambe S, Washington DL, Fink A, Laouri M, Liu H, Scura Fosse J, et al. Waiting times in California’s emergency departments. Ann Emerg Med. 2003;41:35–44. doi: 10.1067/mem.2003.2. - DOI - PubMed
1. Kennedy J, Rhodes K, Walls CA, Asplin BR. Access to emergency care: restricted by long waiting times and cost and coverage concerns. Ann Emerg Med. 2004;43:567–573. doi: 10.1016/j.annemergmed.2003.10.012. - DOI - PubMed
1. Oudhoff JP, Timmermans DR, Rietberg M, Knol DL, van der Wal G. The acceptability of waiting times for elective general surgery and the appropriateness of prioritising patients. BMC Health Serv Res. 2007;7:32. doi: 10.1186/1472-6963-7-32. - DOI - PMC - PubMed
1. Walters JL, Mackintosh S, Sheppard L. The journey to total hip or knee replacement. Aust Health Rev. 2012;36:130–135. doi: 10.1071/AH11050. - DOI - PubMed

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[1] Rotstein D, Alter D. Where does the waiting list begin? A short review of the dynamics and organization of modern waiting lists. Soc Sci Med. 2006;62:3157–3160. doi: 10.1016/j.socscimed.2005.11.030. - DOI - PubMed

[2] Rotstein D, Alter D. Where does the waiting list begin? A short review of the dynamics and organization of modern waiting lists. Soc Sci Med. 2006;62:3157–3160. doi: 10.1016/j.socscimed.2005.11.030. - DOI - PubMed

[3] Lambe S, Washington DL, Fink A, Laouri M, Liu H, Scura Fosse J, et al. Waiting times in California’s emergency departments. Ann Emerg Med. 2003;41:35–44. doi: 10.1067/mem.2003.2. - DOI - PubMed

[4] Lambe S, Washington DL, Fink A, Laouri M, Liu H, Scura Fosse J, et al. Waiting times in California’s emergency departments. Ann Emerg Med. 2003;41:35–44. doi: 10.1067/mem.2003.2. - DOI - PubMed

[5] Kennedy J, Rhodes K, Walls CA, Asplin BR. Access to emergency care: restricted by long waiting times and cost and coverage concerns. Ann Emerg Med. 2004;43:567–573. doi: 10.1016/j.annemergmed.2003.10.012. - DOI - PubMed

[6] Kennedy J, Rhodes K, Walls CA, Asplin BR. Access to emergency care: restricted by long waiting times and cost and coverage concerns. Ann Emerg Med. 2004;43:567–573. doi: 10.1016/j.annemergmed.2003.10.012. - DOI - PubMed

[7] Oudhoff JP, Timmermans DR, Rietberg M, Knol DL, van der Wal G. The acceptability of waiting times for elective general surgery and the appropriateness of prioritising patients. BMC Health Serv Res. 2007;7:32. doi: 10.1186/1472-6963-7-32. - DOI - PMC - PubMed

[8] Oudhoff JP, Timmermans DR, Rietberg M, Knol DL, van der Wal G. The acceptability of waiting times for elective general surgery and the appropriateness of prioritising patients. BMC Health Serv Res. 2007;7:32. doi: 10.1186/1472-6963-7-32. - DOI - PMC - PubMed

[9] Walters JL, Mackintosh S, Sheppard L. The journey to total hip or knee replacement. Aust Health Rev. 2012;36:130–135. doi: 10.1071/AH11050. - DOI - PubMed

[10] Walters JL, Mackintosh S, Sheppard L. The journey to total hip or knee replacement. Aust Health Rev. 2012;36:130–135. doi: 10.1071/AH11050. - DOI - PubMed

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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

Affiliations

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

Authors

Affiliations

Abstract

Conflict of interest statement

Ethics approval and consent to participate

Consent for publication

Competing interests

Publisher’s Note

Figures

Similar articles

Cited by

References

Publication types

MeSH terms

Associated data

LinkOut - more resources

Full Text Sources