pooled referrals

Pooled Referrals Dr Corrine Jabs

This Session is sponsored by:

Pooled Referrals

Dr. Corrine Jabs

Dept Head, Obstetrics & Gynecology

Regina Qu’Appelle Health Region

Inspire Conference, Regina, April 2013

Disclosures

• Speaker’s bureau

– Pfizer

– Astellas

Objectives

• Understand:

– The concept of pooled referrals

– The challenges encountered in implementing the concept of pooled referrals

– The rewards and advantages of pooled referrals

Regina Department of Obstetrics and Gynecology

Department Obstetrics & Gynecology Regina

The Problem

Waitlists

Waitlists

Referral

Consultation

Surgery

Patient need

Department of Obstetrics and Gynecology December 2010

Saskatchewan Specialist Registry

0 0 7 14 14 21 28

365 365 365 365 365

A B C D E F G H I J K L

Days for elective gyne referral to be seen

Issues:

• Long waits for some patients and very short for some patients • Referring docs do not have consistent information regarding

waiting lists. • Overload of some offices, concerns about job security in

others • Multiple requests for referral/lost referrals • Redirected referrals due to overload • Redirected referrals due to skill set • No control over inflow when ill, on leave, etc. • Don’t know overall capacity or backlog in the dept and can’t

predict manpower needs

• Demand = patient need

• Supply = capacity of the providers

• The trick is to balance these

Pooled Referrals

Why consider pooled referrals?

Why Pooled Referrals?

• Patients, through the Patient First Review, stated they want improved access and well coordinated care.

• Pooled referrals is a strategy to reduce wait time variability among a group of specialists that perform similar procedures and helps improve access

The Solution?

What did we want to do?

• Level the workload / Work as a team

• Determine our capacity and backlog as a group

• Reduce wait times for consultation

• Ensure patients are seen by the appropriate specialist/subspecialist (skill task alignment)

• Ensure GPs and patients are kept informed about the status of their referral and appointment

Dept of Obstetrics & Gynecology Regina

“Our Plan”

• As a Department, we agreed to adopt pooled referrals as a quality improvement project to streamline the referral process and improve patient access to our specialists

• Patients now have a CHOICE:

1. they can select a particular specialist, or

2. they can choose to see the next available specialist able to treat their condition

How did we get there? • Sask Surgical Initiative – Pooled Referrals on Agenda Feb 2010

• Discussion – Dept Meeting, Grand Rounds, Suppers Dec 2010 – What were the advantages/disadvantage/risks?

– Effect on Dept, patients and our referring practitioner?

• Practice Matrix – who does what? – Feb 2011

• Referral form – essential for sorting, database – Feb 2011

• Family physician focus group – April 2011

• Business rules – agreement on how to work together –October 2011

• Referral Management System – single entry point/fax line; allocation of referrals; development of database

• Launch April 30, 2012 • Measurement - ongoing

• We were eager to start

• We did not expect perfection from the start

• We anticipated change and challenges

• We are making changes

“Our Challenges”

• Unlike the other early adopters of pooled referrals, our 15 specialists do not share a single office

• Multiple offices multiple fax lines

• Consulting with GPs not an easy task

• Database and Referral Management Service did not exist

• Perfection was expected. People confused because they were expecting this to be a traditional project. We used the PDSA approach: moving from good to better over time

What we did…

Patient Allocation

Impact of Pooling Referrals on: Patient choice

Our Information Given to Referral Management Service

Distribution of Patients in Obstetrics Based on Capacity

Distribution of Patients in Gynecology Based on Capacity and Demand

Other valuable information

Where should we direct our attention?

Impact of Pooling Referrals on: Wait times

Determine our capacity and backlog as a group

Determine our capacity and backlog as a group

Counter measure: urgent wait times

Backlog Reduction

Where is our backlog?

Reducing wait times

What is the Data telling us?

• Wait times for our department are coming down and becoming more consistent.

• For obstetrics: women appear to value their relationship with a particular specialist

• For urgent and elective gynecology issues: women appear to want to have their issues addressed quickly

• We do not need to pool all patients to see improvement (~ 40% of obs, ~ 50% of gyne)

The Value of Data

• This data includes

• number of referrals received,

• reasons for referral,

• capacity of the department as a whole and

• data related to patient waits

The Value of Data

• For the first time ever, we have valuable data about our entire department’s workload

• This data is already proving to be a valuable planning tool for further quality improvement and access initiatives in our department

The Value of Data

• Outliers and anomalies can be identified

• countermeasures can be determined

Who is/will be pooling referrals? Department Region No. of Surgeons “Go Live” Date Orthopedics PAPRHA 4 Live Mar 19, 2012

Ob/gyn RQHR 15 Live -April 30, 2012

Neurosurgery** RQHR 5 Live - June 23, 2011

Neurosurgery** SHR 5 Live -June 23, 2011

General Surgery PAPRHA 5 Live -Nov 22, 2012

Ob/gyn* SHR 9 Live Jan 12, 2013

Thoracic Surgery SHR 3 Self-initiated

Vascular Surgery SHR 4 Self-initiated

Urology SHR 7 Self-initiated

Vascular Surgery RQHR 3 Self-initiated

Cardio-thoracic RQHR 3 Self-initiated

Ob/gyn FHHR 3 Spring 2013

Ob/gyn PNHR 3 Spring 2013

General Surgery PNHR 4 Spring 2013

Plastics SHR 4 Summer 2013

Cardiology SHR 13 Summer 2013

* A group practice of 9 surgeons

** Back pain patients are pooled through the spine pathway, includes several orthopedic

surgeons

Thoughts/Discussion/Questions

Thank you