Electronic Triage:
The pots of gold at the
end of the referral
rainbow •Di Davis November 2013
Background
•

Primary-Secondary Care initiative

•

Driver = Primary care alignment+ safe
transmission

•

9 month develop...
Phased approach
Phase 1 - March 2009
Document generation
Electronic transmission
Receipt acknowledgement
Phase 2 – May 201...
Total ereferrals - March 2009 to present
4500

Phase 2 - electronic
triage

1500

End of paper - June
2013

4000

Phase 1 ...
Change in the processing
times:
Colorectal referrals
Paper

9.8 days

Electronic to the Electronic to the
door
specialist
...
A fast service
Service

Median time to triage (days)

August

September

October

Cardiology

0. 5

0.42

0.67

Respirator...
e-referrals vs FSA appointments - core
specialities
3000
2500
2000
1500
1000
500

Total FSA Delivered

E-Referrals Edited
...
total patients on FSA waiting list for "core
specialties"
4500

4000

3500

3000

2500

2000

Se

pt

3

3

13

-1

g-

l-...
400

eReferrals managed with non contact specialist
advice

350
300
250
200
150
100
50
0
3
-1

3
-1

3

13
pSe

l
Ju

ar

...
Instant messaging
Enabled more appropriate triage
outcomes
Instant messaging
Enabled more appropriate triage
outcomes
More appropriate people in clinic
Instant messaging
Enabled more appropriate triage
outcomes
More appropriate people in clinic
Change in GP referring behavi...
Instant messaging
Enabled more appropriate triage
outcomes
More appropriate people in clinic
Change in GP referring behavi...
Key points
Rising referral numbers with no negative impact on
clinics or waiting lists
Key points
Rising referral numbers with no negative impact on
clinics or waiting lists
20%-25% growth in specialist input ...
Key points
Rising referral numbers with no negative impact on
clinics or waiting lists
20%-25% growth in specialist input ...
Key points
Rising referral numbers with no negative impact on
clinics or waiting lists
20%-25% growth in specialist input ...
Key points
Rising referral numbers with no negative impact on
clinics or waiting lists
20%-25% growth in specialist input ...
Is more possible?
? yes, reframe concept of triage
Process “pots of gold”:
Standardised work
Flexible work
Accountability/ownershi
p
No wrong door
Process “pots of gold”:
Standardised work
Flexible work
Accountability/ownershi
p
No wrong door
Process “pots of gold”:
Standardised work
Flexible work
Accountability/ownership
No wrong door
Process “pots of gold”:
Standardised work
Flexible work
Accountability/ownershi
p
No wrong door
People “pots of gold”
Relationships: GP:SMOs
People “pots of gold”
Relationships: GP:
SMOs
Clinicians driving "next
steps"
The new paradigm…..
Shared care

Primary/secondary
clinical conversations
Shared
planning
eReferrals

Clinical pathways/
g...
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Electronic Triage: The Pots of Gold at the End of the Referral Rainbow

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Presented by Di Davis
Northland District Health Board

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Electronic Triage: The Pots of Gold at the End of the Referral Rainbow

  1. 1. Electronic Triage: The pots of gold at the end of the referral rainbow •Di Davis November 2013
  2. 2. Background • Primary-Secondary Care initiative • Driver = Primary care alignment+ safe transmission • 9 month development phase • Roll-out initiated March 2009 • 100% electronic from 1st June 2013
  3. 3. Phased approach Phase 1 - March 2009 Document generation Electronic transmission Receipt acknowledgement Phase 2 – May 2012 Electronic triage Response to referrer
  4. 4. Total ereferrals - March 2009 to present 4500 Phase 2 - electronic triage 1500 End of paper - June 2013 4000 Phase 1 - electronic transmission 3500 3000 2500 2000 1000 500 0 13 ptSe 3 l-1 Ju 3 y-1 Ma 3 r-1 Ma 3 n -1 Ja 2 v-1 No 12 ptSe 2 l-1 Ju 2 y-1 Ma 2 r-1 Ma 2 n -1 Ja 1 v-1 No 11 ptSe 1 l-1 Ju 1 y-1 Ma 1 r-1 Ma 1 n -1 Ja 0 v-1 No 10 ptSe 0 l-1 Ju 0 y-1 Ma 0 r-1 Ma 0 n -1 Ja 9 v-0 No 09 ptSe 9 l-0 Ju 9 y-0 Ma 9 r-0 Ma
  5. 5. Change in the processing times: Colorectal referrals Paper 9.8 days Electronic to the Electronic to the door specialist 4 days <1 day
  6. 6. A fast service Service Median time to triage (days) August September October Cardiology 0. 5 0.42 0.67 Respiratory 0.75 0.29 0.69 Ophthalmology 1.54 2.06 1.0 Paediatrics 1.83 1.06 2.13 Renal 0.71 0.92 0.75 Gynaecology 0.67 0.33 0.71 Orthopaedics 10.00 14.96 20.4
  7. 7. e-referrals vs FSA appointments - core specialities 3000 2500 2000 1500 1000 500 Total FSA Delivered E-Referrals Edited 0 M ar Ju Se De M ar Ju Se De M ar Ju Se De M ar Ju Se De M ar Ju Se -0 n-0 pt- c -0 -1 n-1 pt- c -1 -1 n-1 pt- c -1 -1 n-1 pt- c -1 -1 n-1 pt9 0 1 2 3 9 09 9 0 10 0 1 11 1 2 12 2 3 13
  8. 8. total patients on FSA waiting list for "core specialties" 4500 4000 3500 3000 2500 2000 Se pt 3 3 13 -1 g- l- 1 Au Ju 13 3 3 -1 n- ay Ju M 3 13 -1 r -1 ar Ap M b- 13 2 2 12 12 v- c- n- Fe Ja De No 2 12 -1 t -1 pt Oc Se g- l- 1 Au Ju 12 2 2 2 -1 nay Ju M -1 r -1 ar Ap M 12 12 bn- Fe Ja
  9. 9. 400 eReferrals managed with non contact specialist advice 350 300 250 200 150 100 50 0 3 -1 3 -1 3 13 pSe l Ju ar -1 12 3 -1 ay M M n Ja vNo 2 -1 12 pSe l Ju 2 -1 ay M
  10. 10. Instant messaging Enabled more appropriate triage outcomes
  11. 11. Instant messaging Enabled more appropriate triage outcomes More appropriate people in clinic
  12. 12. Instant messaging Enabled more appropriate triage outcomes More appropriate people in clinic Change in GP referring behaviour
  13. 13. Instant messaging Enabled more appropriate triage outcomes More appropriate people in clinic Change in GP referring behaviour Is it meeting the GP and patient need?
  14. 14. Key points Rising referral numbers with no negative impact on clinics or waiting lists
  15. 15. Key points Rising referral numbers with no negative impact on clinics or waiting lists 20%-25% growth in specialist input within current resource
  16. 16. Key points Rising referral numbers with no negative impact on clinics or waiting lists 20%-25% growth in specialist input within current resource More appropriate patients in clinic ( top of scope)
  17. 17. Key points Rising referral numbers with no negative impact on clinics or waiting lists 20%-25% growth in specialist input within current resource More appropriate people in clinic (top of scope) GPs managing more within the medical home with specialist support ( top of scope)
  18. 18. Key points Rising referral numbers with no negative impact on clinics or waiting lists 20%-25% growth in specialist input within current resource More appropriate people in clinic (top of scope) GPs managing more within the medical home with specialist support ( top of scope) Non contact input meeting the needs of both GP and patient
  19. 19. Is more possible? ? yes, reframe concept of triage
  20. 20. Process “pots of gold”: Standardised work Flexible work Accountability/ownershi p No wrong door
  21. 21. Process “pots of gold”: Standardised work Flexible work Accountability/ownershi p No wrong door
  22. 22. Process “pots of gold”: Standardised work Flexible work Accountability/ownership No wrong door
  23. 23. Process “pots of gold”: Standardised work Flexible work Accountability/ownershi p No wrong door
  24. 24. People “pots of gold” Relationships: GP:SMOs
  25. 25. People “pots of gold” Relationships: GP: SMOs Clinicians driving "next steps"
  26. 26. The new paradigm….. Shared care Primary/secondary clinical conversations Shared planning eReferrals Clinical pathways/ guidelines

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