pooled referrals
DESCRIPTION
Improvement Story session at the 2013 Saskatchewan Health Care Quality Summit. For more information about the summit, visit www.qualitysummit.ca. Follow @QualitySummit on Twitter. Pooled referrals are quickly becoming a very popular choice among patients being referred to a specialist. Some Saskatchewan specialists that are using pooled referrals are reducing patient wait times by as much as a half. Better Care Corrine JabsTRANSCRIPT
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Pooled Referrals Dr Corrine Jabs
This Session is sponsored by:
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Pooled Referrals
Dr. Corrine Jabs
Dept Head, Obstetrics & Gynecology
Regina Qu’Appelle Health Region
Inspire Conference, Regina, April 2013
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Disclosures
• Speaker’s bureau
– Pfizer
– Astellas
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Objectives
• Understand:
– The concept of pooled referrals
– The challenges encountered in implementing the concept of pooled referrals
– The rewards and advantages of pooled referrals
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Regina Department of Obstetrics and Gynecology
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Department Obstetrics & Gynecology Regina
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The Problem
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Waitlists
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Waitlists
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Referral
Consultation
Surgery
Patient need
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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
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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
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• Demand = patient need
• Supply = capacity of the providers
• The trick is to balance these
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Pooled Referrals
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Why consider pooled referrals?
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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
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The Solution?
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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
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Dept of Obstetrics & Gynecology Regina
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“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
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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
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• We were eager to start
• We did not expect perfection from the start
• We anticipated change and challenges
• We are making changes
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“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
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What we did…
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Patient Allocation
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Impact of Pooling Referrals on: Patient choice
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Our Information Given to Referral Management Service
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Distribution of Patients in Obstetrics Based on Capacity
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Distribution of Patients in Gynecology Based on Capacity and Demand
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Other valuable information
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Where should we direct our attention?
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Impact of Pooling Referrals on: Wait times
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Determine our capacity and backlog as a group
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Determine our capacity and backlog as a group
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Counter measure: urgent wait times
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Backlog Reduction
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Where is our backlog?
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Reducing wait times
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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)
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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
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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
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The Value of Data
• Outliers and anomalies can be identified
• countermeasures can be determined
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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
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Thoughts/Discussion/Questions
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Thank you