Centralized access model improves patient flow and reduces wait times dramatically

The Challenge: Orthopedic services wait times are unacceptably long

Despite the rapid growth in specialization within Canadian healthcare, the referral process that enables patients to access this valuable type of care has remained essentially unchanged for years if not decades. This lack of improvement has led to widespread dissatisfaction among patients, physicians and providers, an unnecessary increase in costs and an unacceptable number of poor experiences and outcomes for patients. This condition has been particularly acute with regard to orthopedic services.

The Improvement Project: Identify and integrate best methods

Elaine Warren is a nurse by training and regional director for surgical services at Newfoundland and Labrador’s Eastern Health. Through her EXTRA intervention project—and supported by Vickie Kaminski, CEO of the Eastern Health regional Health authority in Newfoundland and Labrador—Warren spearheaded her organization’s efforts to redesign the referral process from primary to specialized care so that patients’ access to specialized care would improve. Eastern Health also used this EXTRA intervention to seamlessly integrate into the redesigned process proven methods to manage wait times. Key elements of the project’s evidence-based approach were: orthopedic care best practices in the Bone and Joint Canada Toolkit; IHI Physician Engagement Framework; Kotter’s Change Model; and Pomey’s framework for implementing wait-time management strategies.

The Result: New tool centralizes intake of all orthopedic referrals

Eastern Health developed and introduced a standardized referral tool and a centralized intake and triage model for its full suite of orthopedic services. The new tool enables healthcare officials to establish, collect and share a comprehensive data set related to the demand for orthopedic services. To supplement the tool, Eastern Health developed and implemented methods to reliably match supply and demand for these essential services.

The Impact: Dramatically shorter wait times and improved patient flow

All referrals for patients who require assessment by orthopedic specialists are now managed by one system. As a result of this advance, Eastern Health has reduced the median wait time for orthopedic services for high-priority patients by 72 percent. The median wait time for all other patients who require these services dropped by 45 percent. Improving patient flow further, the new centralized access model has virtually eliminated duplicate referrals and has made wait times for individual physicians nearly the same.

Elaine Warren Elaine Warren
Regional Director
Surgical Services
Eastern Health
St. Johns, Newfoundland
Vickie Kaminski image Vickie Kaminski
CEO, Eastern Health
St. Johns, Newfoundland

To learn more about this project or the EXTRA program, visit cfhi-fcass.ca/EXTRA or email us at info@cfhi-fcass.ca.