Allied Health led Redesign of Non-urgent Outpatient Neurosurgical Spinal Services: a knowledge translation approach

Background Outpatient waiting times for specialist review are a challenge in public health, impacting patients’ quality of life, outcomes, and healthcare system efficiency. Evidence supports a range of strategies to reduce outpatient waiting times including operational efficiencies and physiotherapy clinics. Previous work demonstrates introduced models of care can be effective in reducing waiting lists and provide safe care. The objective was to develop an evidence-based model of care, for future implementation and evaluation, to reduce wait times for outpatient non-urgent specialist neurosurgical patients at a metropolitan hospital in South Australia. Methods Multi-method knowledge translation approach, with the Knowledge to Action Framework was used. Data was gathered for people on the non-urgent neurosurgical waiting list including: 1. Surveys (N = 27), (health care utilization/quality of life); 2. Interviews (N = 12); 3. Audit of hospital utilization (N = 183); and 4. Evidence review completed. Stakeholders workshopped feasible models of care, from collated results (1–4). Models of care were developed to reflect the hospital context, including an estimation of public hospital costs only to inform a local business case. Results Survey and interview results identified patients on the neurosurgical waitlist were negatively impacted, feeling frustrated and demoralised. Emergency Department presentations and inpatient admissions during the wait period were calculated to cost the hospital ≥$116,648 annually. Evidence supports physiotherapists effectively managing non-urgent spinal patients referred for specialist opinion. Stakeholders supported physiotherapy involvement in the neurosurgical clinic with consultant oversight. Preliminary analysis of the model of care supports cost savings and reduced wait times. Conclusion Conceptual frameworks grounded in knowledge translation offer a systematic approach to selecting evidence-based interventions for optimizing outpatient waiting lists in specific health services. Comparative studies are warranted to evaluate the relative effectiveness and sustainability of waiting list reduction strategies informed by such frameworks, versus those developed without the explicit integration of knowledge translation principles.