Lisa Ford, Alieke Van Middelaar, Jennifer Bilton, Alayne Healey, Caroline Ranchhod

Acute Allied Health

Musculo-Skeletal Outpatient Physiotherapy (MSOP) Waitlist Management

‘The Waitlist-ectomy Project’

MSOP Physiotherapy Waitlist Management

Problem background

• MSOP waiting list growing• Waitlist targets not being met• Patients are waiting an unacceptable length of time to receive physiotherapy for their condition

Aim Statements for this project

• By 31 March 2013, 80% of FSA referrals to MSOP will be seen within the set priority timeframes• By 31 July 2013, 95% of FSA referrals to MSOP will be seen within the set priority timeframes

Priority 1 (P1) = to be seen within 4/52 Priority 2 (P2) = to be seen within 6/52

Driver Diagram

By 31 March 2013, 80% of FSA referrals to

MSOP will be seen within the set priority timeframes

By 31 July 2013, 95% of FSA referrals will

be seen within the set priority timeframes

P1 = within 4 weeksP2 = within 6 weeks

Reduce the volume of referrals being received and accepted

by MSOP service

Maximise utilisation of MSOP appointment capacity

Wide MSOP referral criteria

Lack of information given on referrals

Patient consent for referral

Referral method (e.g. post, fax, email)

Under-utilising other physiotherapy providers

Model of care (1:1 vs class)

Managing staff leave

Triage system

Admin process for booking/scheduling

Managing DNA’s and cancellations

Accessibility of clinics (evenings / weekends etc)

Primary DriversAims Secondary Drivers

Name ofMeasure

Is this an Outcome, Process or Balancing

Measure?

Operational Definition (e.g., numerator &

denominator)

Number of referrals received by MSOP per month

Balance Referrals accepted by MSOPMonth

Number of available appt slots per month

Balance Num of MSOP appt slots availableMonth

% of P1 patients seen within 4 weeks. Calculate monthly

Outcome Number of P1 pts seen within 4/52Total P1 on waitlist

% of P2 patients seen within 6 weeks. Calculate monthly

Outcome Number of P2 pts seen within 4/52Total P2 on waitlist

Average number of weeks a P1 patient waits from addition to waitlist

until FSA. Monthly

Outcome Total weeks P1 pts wait for FSATotal P1 pts seen

Average number of weeks a P2 patient waits from addition to waitlist

until FSA. Monthly

Outcome Total weeks P2 pts wait for FSATotal P2 pts seen

Measures

Change Concepts & Ideas for PDSA’sIdea for Testing in a PDSA Theory and prediction about what will happen

when you test this idea

Telephone appt scheduling (instead of sending letter)

Improved efficiency in booking and scheduling will lead to reduced wait times by 3/52

Telephone triaging P1 patients We will reduce the number of patients on the P1 waiting list by 30%

Adding more physiotherapy resource

We will increase capacity to see P1 FSA’s

Telephone triaging for P2 patients

We will reduce the number of patients on the P2 waiting list by 60%

Clearly defining MSOP referral criteria and circulating to

referrers

We will reduce the volume of MSOP referrals accepted by 25%

Prediction: By telephoning patients we will reduce the Priority 1 waitlist by 30%

Aim of this change: To reduce the Priority 1 waitlist by 30% and “clear the backlog”

The Change:

Priority 1 patients are now be contacted by admin team• by phone• within 1 week of receipt of referral •PFB letter sent when no phone contact possible, 14/7 to respond.• 83% have appointment within 4 weeks• Average wait 2.7 weeks in Feb

Measurement% of Priority 1 referrals who did not require appointment and could be removed from waitlist

PLAN:

DO:STUDY:

ACT:

Problem: 70 priority 1 patients on MSOP waitlist, 42 waiting >4 weeks

Physiotherapist will call all patients to triage and either discharge or book appointment within 2-3weeks

55 patients called39 booked within next 10/7

16 removed from waitlist = 29%

Contact patients by phone instead of letter as per patient focused booking (PFB)

Adopt

PDSA: Telephone Appointment Scheduling

Average Number of Weeks a MSOP Referral Waits for FSA (Priority 1 and 2)

0.02.04.06.08.0

10.012.014.016.018.0

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Month / Year

Prediction: Adding more physiotherapy resource will improve FSA throughput.

Aim: Improve access to Physiotherapist FSA appointment i.e. within 4/52 for priority 1 patients

The Change: Available FSA slots 45-50/week

Compared to 30-35 FSA slots/ week in Nov/Dec 2012

Followup patients slots available

Non clinical time is preserved

SH reduced clinical load

Morale boosted!

MeasurementNumber of additional FSA times available

PLAN:

DO:STUDY:

ACT:

Problem: Insufficient Physiotherapist FTE to meet demand

Recruit to longstanding vacant FTE which had been used for other area in AAH, experienced Physiotherapists,

Borrow FTEFill 2/12 rotator vacancy

16/1/13 - borrow 0.2 FTE21/1/13 new 0.5 FTE starts& fill 1.0 rotator position

16/01/13 – 28/02/13Additional

134 x 45 minute appointments

created

F/U patients seen within expected

timeframes

Adopt.

(permanent increase in 0.5 FTE)

Prediction: Telephone triage of priority 2 patients will reduce waitlist by 60%

Aim of this change: Improve waiting time for Priority 2 referrals to 6-10 weeks

The Change:

MeasurementPLAN:

DO:STUDY:

ACT:

Problem: Priority 2 waiting list numbers are increasing and length of wait >12 weeks

Contact patients by phone Instead of letter as per patient focused booking (PFB) due to short timeframes from referral to appointment

February 2013; Physiotherapist will call Priority 2 patients waiting since 1/10/12 to triage and either discharge or book appointment within 4 weeks

Adopt

P2 = 239

75 contacted by phone

15 Removed from waitlist = 20%

(6% of totalP2 waiting)

Re-defining MSOP Referral Criteria

Total Number of MSOP Referrals Accepted - 2010 - 2013

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Current Referral Trends

Total Number of MSOP Referrals Accepted (by priority) 2010 - 2013

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Process Changes and Results

Percentage of P1 MSOP Referrals that Met Waitlist Target (4 weeks)

0%10%20%30%40%50%60%70%80%90%100%

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Process Changes and Results

Percentage of P2 MSOP Referrals that Met Waitlist Target (6 weeks)

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14

Profound Knowledge Worksheet

Appreciation for a System

• Difficulty defining data required

• Difficulty accessing stats

• Human error & technology

Psychology

• Staff morale / motivation

• Behaviour change challenge

• Pressure from referrers

• Team work

Theory of Knowledge• How are our prioritisation time frames set?

• •

Understanding Variation • Staff triaging differently

• Admin process variation around DNA’s and cancellations (different from other OP services)

Where to from here?

•TEAMWORK & Sustainability of gains to-date

•Stats available weekly for closer monitoring

•Closer look at capacity/week+ Recruitment!!

•FSA as classes vs individual appointments

•Priority 2 phone triage strategy

•FOCUS to achieve 80% of referrals seen within timeframes by 31/7/13