Pooled ReferralsDr Corrine JabsThis Session is sponsored by:
Pooled ReferralsDr. Corrine JabsDept Head, Obstetrics & GynecologyRegina Qu’Appelle Health RegionInspire Conference, Regin...
Disclosures• Speaker’s bureau– Pfizer– Astellas
Objectives• Understand:– The concept of pooled referrals– The challenges encountered in implementing theconcept of pooled ...
Regina Department of Obstetrics andGynecology
Department Obstetrics & GynecologyRegina
The Problem
Waitlists
Waitlists
ReferralConsultationSurgeryPatient need
Department of Obstetrics and Gynecology December2010Saskatchewan Specialist Registry0 0 7 14 14 21 28365 365 365 365 365A ...
Issues:• Long waits for some patients and very short for some patients• Referring docs do not have consistent information ...
• Demand = patient need• Supply = capacity of the providers• The trick is to balance these
Pooled Referrals
Why considerpooled referrals?
Why Pooled Referrals?• Patients, through the Patient First Review,stated they want improved access and wellcoordinated car...
The Solution?
What did we want to do?• Level the workload / Work as a team• Determine our capacity and backlog as a group• Reduce wait t...
Dept of Obstetrics & Gynecology Regina
“Our Plan”• As a Department, we agreed to adopt pooledreferrals as a quality improvement project tostreamline the referral...
How did we get there?• Sask Surgical Initiative – Pooled Referrals on Agenda Feb 2010• Discussion – Dept Meeting, Grand Ro...
• We were eager to start• We did not expectperfection from the start• We anticipated change andchallenges• We are making c...
“Our Challenges”• Unlike the other early adopters of pooled referrals, our 15specialists do not share a single office• Mul...
What we did…
Patient Allocation
Impact of Pooling Referrals on:Patient choice
Our Information Given to ReferralManagement Service
Distribution of Patients in ObstetricsBased on Capacity
Distribution of Patients in GynecologyBased on Capacity and Demand
Other valuable information
Where should we direct our attention?
Impact of Pooling Referrals on:Wait times
Determine our capacity and backlogas a group
Determine our capacity and backlogas a group
Counter measure: urgent wait times
Backlog Reduction
Where is our backlog?
Reducing wait times
What is the Data telling us?• Wait times for our department are coming down andbecoming more consistent.• For obstetrics: ...
The Value of Data• This data includes• number of referrals received,• reasons for referral,• capacity of the department as...
The Value of Data• For the first time ever, we have valuable data aboutour entire department’s workload• This data is alre...
The Value of Data• Outliers and anomalies can be identified• countermeasures can be determined
Who is/will be pooling referrals?Department Region No. of Surgeons “Go Live” DateOrthopedics PAPRHA 4 Live Mar 19, 2012Ob/...
Thoughts/Discussion/Questions
Thank you
Pooled Referrals
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Pooled Referrals

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Improvement Story session at the 2013 Saskatchewan Health Care Quality Summit. For more information about the summit, visit www.qualitysummit.ca. Follow @QualitySummit on Twitter.

Pooled referrals are quickly becoming a very popular choice among patients being referred to a specialist. Some Saskatchewan specialists that are using pooled referrals are reducing patient wait times by as much as a half.
Better Care

Corrine Jabs

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Pooled Referrals

  1. 1. Pooled ReferralsDr Corrine JabsThis Session is sponsored by:
  2. 2. Pooled ReferralsDr. Corrine JabsDept Head, Obstetrics & GynecologyRegina Qu’Appelle Health RegionInspire Conference, Regina, April 2013
  3. 3. Disclosures• Speaker’s bureau– Pfizer– Astellas
  4. 4. Objectives• Understand:– The concept of pooled referrals– The challenges encountered in implementing theconcept of pooled referrals– The rewards and advantages of pooled referrals
  5. 5. Regina Department of Obstetrics andGynecology
  6. 6. Department Obstetrics & GynecologyRegina
  7. 7. The Problem
  8. 8. Waitlists
  9. 9. Waitlists
  10. 10. ReferralConsultationSurgeryPatient need
  11. 11. Department of Obstetrics and Gynecology December2010Saskatchewan Specialist Registry0 0 7 14 14 21 28365 365 365 365 365A B C D E F G H I J K LDays for elective gyne referral to be seen
  12. 12. Issues:• Long waits for some patients and very short for some patients• Referring docs do not have consistent information regardingwaiting lists.• Overload of some offices, concerns about job security inothers• Multiple requests for referral/lost referrals• Redirected referrals due to overload• Redirected referrals due to skill set• No control over inflow when ill, on leave, etc.• Don’t know overall capacity or backlog in the dept and can’tpredict manpower needs
  13. 13. • Demand = patient need• Supply = capacity of the providers• The trick is to balance these
  14. 14. Pooled Referrals
  15. 15. Why considerpooled referrals?
  16. 16. Why Pooled Referrals?• Patients, through the Patient First Review,stated they want improved access and wellcoordinated care.• Pooled referrals is a strategy to reduce waittime variability among a group of specialiststhat perform similar procedures and helpsimprove access
  17. 17. The Solution?
  18. 18. What did we want to do?• Level the workload / Work as a team• Determine our capacity and backlog as a group• Reduce wait times for consultation• Ensure patients are seen by the appropriatespecialist/subspecialist (skill task alignment)• Ensure GPs and patients are kept informed about thestatus of their referral and appointment
  19. 19. Dept of Obstetrics & Gynecology Regina
  20. 20. “Our Plan”• As a Department, we agreed to adopt pooledreferrals as a quality improvement project tostreamline the referral process and improve patientaccess to our specialists• Patients now have a CHOICE:1. they can select a particular specialist, or2. they can choose to see the next available specialist able totreat their condition
  21. 21. How did we get there?• Sask Surgical Initiative – Pooled Referrals on Agenda Feb 2010• Discussion – Dept Meeting, Grand Rounds, Suppers Dec 2010– What were the advantages/disadvantage/risks?– Effect on Dept, patients and our referring practitioner?• Practice Matrix – who does what? – Feb 2011• Referral form – essential for sorting, database – Feb 2011• Family physician focus group – April 2011• Business rules – agreement on how to work together –October 2011• Referral Management System – single entry point/fax line; allocationof referrals; development of database• Launch April 30, 2012• Measurement - ongoing
  22. 22. • We were eager to start• We did not expectperfection from the start• We anticipated change andchallenges• We are making changes
  23. 23. “Our Challenges”• Unlike the other early adopters of pooled referrals, our 15specialists do not share a single office• Multiple offices multiple fax lines• Consulting with GPs not an easy task• Database and Referral Management Service did not exist• Perfection was expected. People confused because they wereexpecting this to be a traditional project. We used the PDSAapproach: moving from good to better over time
  24. 24. What we did…
  25. 25. Patient Allocation
  26. 26. Impact of Pooling Referrals on:Patient choice
  27. 27. Our Information Given to ReferralManagement Service
  28. 28. Distribution of Patients in ObstetricsBased on Capacity
  29. 29. Distribution of Patients in GynecologyBased on Capacity and Demand
  30. 30. Other valuable information
  31. 31. Where should we direct our attention?
  32. 32. Impact of Pooling Referrals on:Wait times
  33. 33. Determine our capacity and backlogas a group
  34. 34. Determine our capacity and backlogas a group
  35. 35. Counter measure: urgent wait times
  36. 36. Backlog Reduction
  37. 37. Where is our backlog?
  38. 38. Reducing wait times
  39. 39. What is the Data telling us?• Wait times for our department are coming down andbecoming more consistent.• For obstetrics: women appear to value theirrelationship with a particular specialist• For urgent and elective gynecology issues: womenappear to want to have their issues addressedquickly• We do not need to pool all patients to seeimprovement (~ 40% of obs, ~ 50% of gyne)
  40. 40. The Value of Data• This data includes• number of referrals received,• reasons for referral,• capacity of the department as a whole and• data related to patient waits
  41. 41. The Value of Data• For the first time ever, we have valuable data aboutour entire department’s workload• This data is already proving to be a valuable planningtool for further quality improvement and accessinitiatives in our department
  42. 42. The Value of Data• Outliers and anomalies can be identified• countermeasures can be determined
  43. 43. Who is/will be pooling referrals?Department Region No. of Surgeons “Go Live” DateOrthopedics PAPRHA 4 Live Mar 19, 2012Ob/gyn RQHR 15 Live -April 30, 2012Neurosurgery** RQHR 5 Live - June 23, 2011Neurosurgery** SHR 5 Live -June 23, 2011General Surgery PAPRHA 5 Live -Nov 22, 2012Ob/gyn* SHR 9 Live Jan 12, 2013Thoracic Surgery SHR 3 Self-initiatedVascular Surgery SHR 4 Self-initiatedUrology SHR 7 Self-initiatedVascular Surgery RQHR 3 Self-initiatedCardio-thoracic RQHR 3 Self-initiatedOb/gyn FHHR 3 Spring 2013Ob/gyn PNHR 3 Spring 2013General Surgery PNHR 4 Spring 2013Plastics SHR 4 Summer 2013Cardiology SHR 13 Summer 2013* A group practice of 9 surgeons** Back pain patients are pooled through the spine pathway, includes several orthopedicsurgeons
  44. 44. Thoughts/Discussion/Questions
  45. 45. Thank you

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