Wait times, health care touchpoints, and nonattendance in an academic pediatric dermatology clinic

Stephens, Michael; Murthy, Aditi; McMahon, Patrick J.

doi:10.1111/pde.13943

Cited by 23 publications

(29 citation statements)

References 13 publications

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“…Attendance rates in paediatric outpatient services are traditionally poor and high non‐attendance rates are an additional cost to the service. Although the non‐attendance rates in this study appear to be substantial, they are in line with reported attendance rates for paediatric services generally 14,15 . Comparing the two groups, the likelihood of attendance was 2.6 times higher for the AA group for their first appointment compared to the ENT group.…”

Section: Discussionsupporting

confidence: 83%

“…Comparing the two groups, the likelihood of attendance was 2.6 times higher for the AA group for their first appointment compared to the ENT group. Longer waiting times have been shown to be significantly associated with reduced attendance rates in paediatric dermatological outpatient services, 15 as well as non‐attendance rates increasing during the winter to spring months suggesting a seasonal element. In the case of middle ear disease, it is possible that children who have been waiting longer no longer require the service to which they have been referred due to the transient nature of a substantial proportion of middle ear disease.…”

Section: Discussionmentioning

confidence: 99%

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Can an advanced audiology‐led service reduce waiting times for paediatric ear nose and throat outpatient services?

Pokorny

Thorne

Whitfield

et al. 2020

J Paediatrics Child Health

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Aim Children with middle ear disease often experience lengthy delays waiting for outpatient paediatric ear nose and throat (ENT) services. This study aimed to investigate whether an alternative service delivery model using audiologists working in an expanded scope of practice reduced waiting times for children to access such services. Methods A total of 131 children consecutively referred to a large ENT outpatient service in Queensland, Australia, for middle ear and hearing concerns were prospectively allocated to either a standard ENT service or an advanced audiology (AA)‐led service. Waiting times and attendance rates were collected and compared between the two patient groups. Results The median waiting time from referral to first offered appointment was 96 days for children in the AA‐led service versus 417.5 days for children in the standard ENT service. Seventy‐nine percent of children in the AA‐led service attended their first offered appointment versus 61% in the standard ENT service. For children receiving grommets, the median waiting time from initial referral to grommet insertion was 226 days for children in the AA‐led service versus 627 days for children in the standard ENT service. Conclusion The AA‐led service was an effective alternative pathway to reduce waiting times for children referred to ENT services with middle ear and hearing concerns.

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Section: Discussionsupporting

confidence: 83%

Section: Discussionmentioning

confidence: 99%

Can an advanced audiology‐led service reduce waiting times for paediatric ear nose and throat outpatient services?

Pokorny

Thorne

Whitfield

et al. 2020

J Paediatrics Child Health

View full text Add to dashboard Cite

show abstract

“…Younger age has been associated with increased visits to primary care and the emergency department in response to long wait times for pediatric dermatology appointments 15 . Patients who received a recommendation for FTF evaluation were younger on average than those who did not, and the eConsult program helped hasten their access to dermatology recommendations (Table 1).…”

Section: Discussionmentioning

confidence: 99%

Pediatric dermatology eConsults: Reduced wait times and dermatology office visits

Seiger

Hawryluk

Kroshinsky

et al. 2020

Pediatric Dermatology

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Background/Objectives: Store-and-forward teledermatology provides pediatricians with specialist guidance in managing skin disease. This study evaluates wait times and face-to-face (FTF) dermatology visit avoidance associated with a pediatric dermatology eConsult program at an urban academic medical center. Methods: In this retrospective cohort study, electronic medical records were reviewed for patients under age 18 for whom a dermatology eConsult was completed between November 1, 2014, and December 31, 2017. Wait times for eConsult completion and initial FTF dermatology appointments were calculated and compared to average wait times for new patient dermatology office appointments from 2016 to 2017. Recommendations for FTF dermatology visits were assessed, along with FTF visit attendance and potential cost savings. Results: One hundred eighty pediatric patients with 188 unrelated skin conditions ("cases") were referred to the program. Of 188 cases, FTF dermatology visits were recommended for 60 (31.9%). Actual FTF dermatology visit avoidance was 53.7% of total cases (n = 101 for whom FTF visit was not recommended and no dermatology visit occurred within 90 days after eConsult submission). The program generated potential savings of $24 059 ($9840 out-of-pocket) in 2016 dollars. Average turnaround for eConsult completion was 1.8 calendar days (median: 1 calendar day, target: 2 business days). Average wait time to initial FTF dermatology evaluation was 37.3 calendar days (versus 54.1 days for pediatric patients referred directly to dermatology clinic between 2016 and 2017). Conclusion: Pediatric dermatology eConsults reduce wait times for specialist care, triage cases for in-office evaluation, reduce need for FTF dermatology visits, and offer potential cost savings for payers and patients. K E Y W O R D S eConsults, health care delivery, store-and-forward teledermatology | 805 Pediatric Dermatology SEIGER Et al.

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“…In the control study, patients referred to a pediatric dermatologist waited on average 80 days for an in-person appointment, with longer wait times associated with increased rates of interim health care touchpoints, appointment cancelation, and failure to attend (noshow) a scheduled outpatient visit. 9 found that once established with a provider, patients may be reluctant to switch from one provider to another. 10,11 While teledermatology has the potential to expand access for patients in need, downstream consequences should be considered, such as creation of additional work for PCP and consulting specialists.…”

Section: Areas For Improvementmentioning

confidence: 99%

Implementation of a pediatric provider‐to‐provider store‐and‐forward teledermatology system: Effectiveness, feasibility, and acceptability in a pilot study

Jew

Murthy

Danley

et al. 2020

Pediatric Dermatology

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Background/Objectives: Long wait times for in-person appointments in pediatric dermatology can lead to delays in specialty care, additional health system touchpoints, patient and family dissatisfaction, poorer outcomes, and increased overall health care costs. Store-and-forward teledermatology may address these challenges and improve access to care in pediatric dermatology. Methods: We describe a prospective, non-blinded cohort study with follow-up surveys conducted from March 1, 2018, to September 20, 2018. The study was conducted at a single center, in primary care and specialist settings. Patients included were <18 years old and received care at one of our affiliated primary care sites. Primary care providers submitted teledermatology consultations through a shared electronic medical record. A board-certified pediatric dermatologist evaluated each consultation; primary care providers conveyed recommendations to families. Results: Forty-three consultations for patients (23 male, 20 female; median age: 7 years [IQR: 2.4-12]) were entered by primary care providers. Median time from consult request to dermatologist initiating consult was 12.1 hours [IQR: 1.9-18.8]; median time to complete consult note was 7 minutes [IQR: 5-10.5]. Median time from primary care provider initially consulting to conveying teledermatology recommendations to families was 3 days [IQR: 1-5]. All but one consult (42/43, 98%) were completed in the intended workflow. Follow-up in-person visits with pediatric dermatologists occurred with 10/43 (23%) patients. In follow-up surveys, parents were 83% likely to recommend the service to family and friends. All primary care providers and dermatologists felt the service improved quality of care. Conclusions: Provider-to-provider teledermatology consultation appears to be a feasible and acceptable method of providing care quickly and effectively to pediatric patients.

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Wait times, health care touchpoints, and nonattendance in an academic pediatric dermatology clinic

Cited by 23 publications

References 13 publications

Can an advanced audiology‐led service reduce waiting times for paediatric ear nose and throat outpatient services?

Can an advanced audiology‐led service reduce waiting times for paediatric ear nose and throat outpatient services?

Pediatric dermatology eConsults: Reduced wait times and dermatology office visits

Implementation of a pediatric provider‐to‐provider store‐and‐forward teledermatology system: Effectiveness, feasibility, and acceptability in a pilot study

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