pooled referrals

46
Pooled Referrals Dr Corrine Jabs This Session is sponsored by:

Upload: saskatchewan-health-care-quality-summit

Post on 07-Jun-2015

452 views

Category:

Health & Medicine


2 download

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 Jabs

TRANSCRIPT

Page 1: Pooled Referrals

Pooled Referrals Dr Corrine Jabs

This Session is sponsored by:

Page 2: Pooled Referrals

Pooled Referrals

Dr. Corrine Jabs

Dept Head, Obstetrics & Gynecology

Regina Qu’Appelle Health Region

Inspire Conference, Regina, April 2013

Page 3: Pooled Referrals

Disclosures

• Speaker’s bureau

– Pfizer

– Astellas

Page 4: Pooled Referrals

Objectives

• Understand:

– The concept of pooled referrals

– The challenges encountered in implementing the concept of pooled referrals

– The rewards and advantages of pooled referrals

Page 5: Pooled Referrals

Regina Department of Obstetrics and Gynecology

Page 6: Pooled Referrals

Department Obstetrics & Gynecology Regina

Page 7: Pooled Referrals

The Problem

Page 8: Pooled Referrals

Waitlists

Page 9: Pooled Referrals

Waitlists

Page 10: Pooled Referrals

Referral

Consultation

Surgery

Patient need

Page 11: Pooled Referrals

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

Page 12: Pooled Referrals

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

Page 13: Pooled Referrals

• Demand = patient need

• Supply = capacity of the providers

• The trick is to balance these

Page 14: Pooled Referrals

Pooled Referrals

Page 15: Pooled Referrals

Why consider pooled referrals?

Page 16: 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

Page 17: Pooled Referrals

The Solution?

Page 18: Pooled Referrals

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

Page 19: Pooled Referrals

Dept of Obstetrics & Gynecology Regina

Page 20: Pooled Referrals

“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

Page 21: Pooled Referrals

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

Page 22: Pooled Referrals

• We were eager to start

• We did not expect perfection from the start

• We anticipated change and challenges

• We are making changes

Page 23: Pooled Referrals

“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

Page 24: Pooled Referrals

What we did…

Page 25: Pooled Referrals
Page 26: Pooled Referrals

Patient Allocation

Page 27: Pooled Referrals

Impact of Pooling Referrals on: Patient choice

Page 28: Pooled Referrals

Our Information Given to Referral Management Service

Page 29: Pooled Referrals

Distribution of Patients in Obstetrics Based on Capacity

Page 30: Pooled Referrals

Distribution of Patients in Gynecology Based on Capacity and Demand

Page 31: Pooled Referrals

Other valuable information

Page 32: Pooled Referrals

Where should we direct our attention?

Page 33: Pooled Referrals

Impact of Pooling Referrals on: Wait times

Page 34: Pooled Referrals

Determine our capacity and backlog as a group

Page 35: Pooled Referrals

Determine our capacity and backlog as a group

Page 36: Pooled Referrals

Counter measure: urgent wait times

Page 37: Pooled Referrals

Backlog Reduction

Page 38: Pooled Referrals

Where is our backlog?

Page 39: Pooled Referrals

Reducing wait times

Page 40: Pooled Referrals

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)

Page 41: Pooled Referrals

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

Page 42: Pooled Referrals

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

Page 43: Pooled Referrals

The Value of Data

• Outliers and anomalies can be identified

• countermeasures can be determined

Page 44: Pooled Referrals

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

Page 45: Pooled Referrals

Thoughts/Discussion/Questions

Page 46: Pooled Referrals

Thank you