A systematic review of patient prioritization tools in non-emergency healthcare services

Abstract

Background. Patient prioritization is a strategy used to manage access to healthcare services. Patient prioritization tools (PPT) contribute to supporting the prioritization decision process, and to its transparency and fairness. Patient prioritization tools can take various forms and are highly dependent on the particular context of application. Consequently, the sets of criteria change from one context to another, especially when used in non-emergency settings. This paper systematically synthesizes and analyzes the published evidence concerning the development and challenges related to the validation and implementation of PPTs in non-emergency settings.Methods. We conducted a systematic mixed studies review. We searched evidence in five databases to select articles based on eligibility criteria, and information of included articles was extracted using an extraction grid. The methodological quality of the studies was assessed by using the Mixed Methods Appraisal Tool. The article selection process, data extraction, and quality appraisal were performed by at least two reviewers independently.Results. We included 48 studies listing 34 different patient prioritization tools. Most of them are designed for managing access to elective surgeries in hospital settings. Two thirds of the tools were investigated based on reliability or validity. Inconclusive results were found regarding the impact of PPTs on patient waiting times. Advantages associated with PPT use were found mostly in relationship to acceptability of the tools by clinicians and increased transparency and equity for patients.Conclusions. This review describes the development and validation processes of PPTs used in non-urgent healthcare settings. Despite the large number of PPTs studied, implementation into clinical practice seems to be an open challenge. Based on the findings of this review, recommendations are proposed to develop, validate, and implement such tools in clinical settings.Systematic review registration: PROSPERO CRD42018107205

Time for You: A process evaluation of the rapid implementation of a multi-level mental health support intervention for frontline workers during the COVID-19 pandemic

“…Frontline workers from 31 out of the 32 local authority areas in Scotland accessed the Time for You service, with Shetland being the only local authority area not represented within the sample. Service users were mainly based in the following locations: City of Glasgow (80), North Lanarkshire and South Lanarkshire (55) and Aberdeen City/ Aberdeenshire (26). From the eight employment sectors in the full data set, the highest number of service users were in the Health Care sector (106) followed by Social Care (94) and Education (37).…”

“…Such signposting was present in the Time for You intervention, but the experiences of trainees and service users suggested that it was sub-optimal. Effective triage systems may improve the client journey [54] though the availability of validated and effective ways of achieving this in nonurgent healthcare settings has been highlighted as a currently unresolved task [55] and may be particularly challenging when treatment options involve a mixture of both independent and supported treatment option as is the case with Time for You.…”