Service redesign interventions to reduce waiting time for paediatric rehabilitation and therapy services: A systematic review of the literature

Abstract

Despite well-documented benefits of rehabilitation and therapy services for children with disabilities, long waiting lists to access these services are common. There is a growing body of evidence, primarily from mixed or adult services, demonstrating that waiting times can be reduced through strategies that target wasteful processes and support services to keep up with demand. However, providers of rehabilitation and therapy services for children face additional complexities related to the long-term nature of many developmental conditions and the need to consider timing of interventions with developmental milestones and education transition points. This review aimed to synthesise available evidence on service redesign strategies in reducing waiting time for paediatric therapy services. We conducted a systematic review of studies conducted in outpatient paediatric rehabilitation or therapy settings, including physical and mental health services, evaluating a service redesign intervention and presenting comparative data on time to access care. Two reviewers independently applied inclusion criteria, assessed risk of bias and extracted data. Findings were analysed descriptively and the certainty of evidence was synthesised according to criteria for health service research. From 1934 studies identified, 33 met the criteria for inclusion. Interventions were categorised as rapid response strategies, process efficiency interventions or substitution strategies (using alternative providers in place of medical specialists). Reductions in waiting time were reported in 30 studies. Evidence is limited by study designs with high risk of bias, but this is mitigated by consistency of findings and large effect sizes. There is moderate-certainty evidence that service redesign strategies similar to those used in adult populations can be applied in paediatric rehabilitation and therapy settings to reduce waiting time.

Sustainability of an intervention to reduce waiting for access to an epilepsy outpatient clinic

“…However, managing demand to ensure timely care in non-admitted health services is complex. Interventions to reduce waiting time have been reported across a diverse range of services, providing a growing body of evidence to suggest that lengthy waitlists are not inevitable [ [3] , [4] , [5] ]. A key issue is that evaluations of interventions to reduce delays and improve patient flow in outpatient settings rarely report on sustainability [ 6 ] despite the risk that once resources to address the problem are withdrawn, waitlists and delays can return [ 7 ].…”

Unraveling attrition and retention: A qualitative study with rehabilitation professionals

“…While rehabilitation interventions offer many benefits, access can be challenging for those who need them most. In many health care systems, services such as outpatient pediatric rehabilitation services, are limited and hard to access [4,5] while in others, they are unavailable [6,7]. Several factors contribute to these challenges, including an increase in demand for services, partly due to the increasing incidence of chronic diseases and comorbidities, [8,9] shifting demographics and an aging population [10,11].…”

An evidence‐based demand management strategy using a hub and spoke training model reduces waiting time for children's therapy services: An implementation trial

“…However, there are often other contributing factors that can be addressed to improve timely access to care. Two systematic reviews provide more than 60 examples of outpatient and community health services that have reduced waiting lists and improved access by implementing strategies that reduce wasteful processes or adjust models of service delivery to restore the balance between supply and demand (Dupuis et al, 2022; Harding et al, 2022). Some of these strategies include allocating new referrals directly to protected initial appointments (Murray & Berwick, 2003), combining triage and initial assessment at the point of service (Harding et al, 2011) and service redesign approaches that eliminate processes that do not add value to client care (Bowen & Youngdahl, 1998).…”