Staff perspectives of a model of access and triage for reducing waiting time in ambulatory services: a qualitative study

Abstract

Background Specific Timely Appointments for Triage (STAT) is an intervention designed to reduce waiting time in community outpatient health services, shown to be effective in a large stepped wedge cluster randomised controlled trial. STAT combines initial strategies to reduce existing wait lists with creation of a specific number of protected appointments for new patients based on demand. It offers an alternative to the more traditional methods of demand management for these services using waiting lists with triage systems. This study aimed to explore perceptions of clinicians and administrative staff involved in implementing the model. Method Semi-structured interviews with 20 staff members who experienced the change to STAT were conducted by an independent interviewer. All eight sites involved in the original trial and all professional disciplines were represented in the sample. Data were coded and analysed thematically. Results Participants agreed that shorter waiting time for patients was the main advantage of the STAT model, and that ongoing management of caseloads was challenging. However, there was variation in the overall weight placed on these factors, and therefore the participants’ preference for the new or previous model of care. Perceptions of whether the advantages outweighed the disadvantages were influenced by five sub-themes: staff perception of how much waiting matters to the patient, prior exposure to the management of waiting list, caseload complexity, approach and attitude to the implementation of STAT and organisational factors. Conclusions The STAT model has clear benefits but also presents challenges for staff members. The findings of this study suggest that careful preparation and management of change and active planning for known fluctuations in supply and demand are likely to help to mitigate sources of stress and improve the likelihood of successful implementation of the STAT model for improving waiting times for patients referred to community outpatient services.

Reducing the waitlist of referred patients in a medical specialist outpatient clinic: an observational study

“…In a time-pressured environment, the clinic administrators concentrated their efforts on booking recent referrals, while a large, and inaccurate, waitlist developed. The perception, confirmed by the audit, that long waiters were unlikely to want or need the service may contribute to an apparent acceptance of long waitlists by clinic staff and managers, consistent with findings in ambulatory and community settings (Harding et al , 2019).…”

A translational triage research development tool: standardizing prehospital triage decision-making systems in mass casualty incidents

“…Having this in mind, the continuous emergence of new triage systems may witness the lack of a reliable solution and flaws in all prehospital protocols, which neither may be translated into true clinical value and diagnostic substance, nor demonstrate evidence or validity [ 20 , 61 ]. Nevertheless, they definitely demonstrate organizational and management advantages and should be adjusted, if possible [ 62 ].…”

Return on investment of a model of access combining triage with initial management: an economic analysis

“… 12 36 Clinicians identified that the main advantage of the STAT model was that patients could receive a healthcare intervention sooner which had positive impacts on their health outcomes. 33 Therefore, it is possible that patients in the STAT group may have been healthier at the time of admission because they had a shorter wait time for health service input. Consequently, it is difficult to predict the directional relationship between utility scores and healthcare costs.…”