Service redesign for Outpatient Services: Strategies to improve the wait.

ObjectiveTo assess the effectiveness of a multicomponent waitlist optimisation strategy on the proportion of patients overdue to be seen for a neurosurgical (spinal pain) outpatient service at an Australian public hospital.MethodsAn interrupted time series study in the outpatient department of a tertiary referral hospital in New South Wales, Australia. We implemented seven of waitlist optimisation strategies aimed at improving appropriate referrals and addressing extended neurosurgical wait times for spinal pain. We compared a pre-implementation phase (January 2015–January 2016, a transition phase (February 2016–December 2017), and a post-implementation phase (January 2018–January 2020). We included data from all adults who had been referred for neck and back pain to the neurosurgical outpatient service. The primary outcome was the proportion of patients overdue to be seen (based on their triage category) for a given month. Secondary outcomes were: i) proportion of patients that were waiting longer than one year for an initial appointment for a given month and ii) the total neurosurgical waitlist number.ResultsWe included data from 11,520 unique individuals who had a mean age of 54 years (SD 17), 51% (5,900) were female, and 8.8% (1,004) identified as Aboriginal and/or Torres Strait Islander. Across the three phases, there were 26,928 monthly data points pre-implementation, 36,009 transition, and 15,326 post-implementation. Our primary model showed a 7% reduction (OR 0.93 [95% CI 0.89,0.97]) in the odds of being overdue to be seen in the post-implementation phase, compared to pre-implementation. We observed a reduction in the monthly average number of patients on the neurosurgical waitlist from pre-implementation (2,071 [SD 171]) to post-implementation (613 [SD 96]).ConclusionThe waitlist optimisation strategies tested in this study led to a large reduction in the proportion of patients overdue to be seen on the neurosurgical waitlist, as well as the proportion of patients waiting longer than one year for an initial appointment and the total neurosurgical waitlist number. The tested strategies can be used by other services to address extended waits in outpatient services.