Academic journal article Australian Health Review

Clinician and Patient Perspectives of a New Model of Triage in a Community Rehabilitation Program That Reduced Waiting Time: A Qualitative Analysis

Academic journal article Australian Health Review

Clinician and Patient Perspectives of a New Model of Triage in a Community Rehabilitation Program That Reduced Waiting Time: A Qualitative Analysis

Article excerpt

Introduction

Waiting forhealthcare is a widespread problem in health services1 and is often considered to be an inevitable consequence of excessive demand for insufficient resources.2,3 However, long waiting times are not always the product of an imbalance between supply and demand, but also result from inefficiencies in patient flow.2 Triage systems intended to manage waiting lists can confound these issues by diverting resources from the frontline while offering limited reliability,4-6 having minimal impact on patient care7 and adding inefficiencies by creating separate queues.8

We designed and tested an alternative to the traditional 'wait list and triage' approach for a community rehabilitation program (CRP), called 'Specific and Timely Appointments for Triage' (STAT). In the STAT model, clinicians created a specified number of assessment times in their weekly schedule based on the average number of referrals per week and were asked to use their clinical judgement to prioritise and manage their own caseload. On referral, patients were contacted by the team leader and immediately booked into the first available appointment (Fig. 1). STAT was evaluated in a controlled before and after trial, and reduced waiting time from a mean 17.5 to 10.0 days at the intervention site, with no change at a control site continuing to use a wait list and four-category triage model. Patients were also 3.3 times more likely to be seen within 7 days than control site patients (95% CI 2.2-4.9).9 The use of group treatments increased at the intervention site (from 1.9 to 4.3 sessions per patient, P < 0.01), but STAT used no additional resources, and had no adverse impact on quality of life scores or unplanned hospital admissions within 6 months of referral.

However, these figures tell us little about the impact of the system on the patients and clinicians involved. The patient perspective is an important component in the evaluation of the quality of health services,10,11 as are the links between staff morale, job satisfaction, performance and turnover.12 As a result, an informed decision about the usefulness of STAT cannot be based on reductions in waiting time alone, but should also explore whether it was acceptable to clinicians and made any difference to the experiences of patients.

We aimed to explore the perceptions of clinicians who experienced the change from the traditional triaged wait list model to STAT, patients who entered rehabilitation under STAT, and patients who entered rehabilitation under the traditional approach of a wait list managed with a triage system.

Methods

Setting

The study was conducted at two sites of a publicly funded multidisciplinary, musculoskeletal CRP within a large metropol- itan health service.9

Design

Mixed-methods approaches utilise a combination of qualitative and quantitative methodologies within a single study to increase breadth and depth of understanding.13,14 A convergent mixed- methods design was used,15 simultaneously collecting both qualitative and quantitative data for analysis and comparison. The quantitative results have been reported elsewhere;9 this paper reports the results of the qualitative analysis.

In-depth semi-structured interviews were conducted to ex- plore the experiences of the clinicians who worked in the team during the period of transition from the existing model to the STAT model of care, patients who had experienced STAT, and patients who were admitted to the CRP from wait list and triage. These three perspectives allowed for triangulation of the data, contributing to the validity of the findings and ensuring comprehensiveness.16

Ethical approval was obtained from both the hospital and affiliated university human ethics committees and participants gave written informed consent to participate.

Participants

All clinicians who worked in the team at the time the new STAT model was introduced were invited to participate. …

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