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Musculo-Skeletal Outpatient Physiotherapy (MSOP) Waitlist Management

Musculo-Skeletal Outpatient Physiotherapy (MSOP) Waitlist Management ‘The W aitlist-ectomy Project’. Lisa Ford, Alieke Van Middelaar, Jennifer Bilton, Alayne Healey, Caroline Ranchhod Acute Allied Health. MSOP Physiotherapy Waitlist Management. Problem background MSOP waiting list growing

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Musculo-Skeletal Outpatient Physiotherapy (MSOP) Waitlist Management

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  1. Musculo-Skeletal Outpatient Physiotherapy (MSOP) Waitlist Management ‘The Waitlist-ectomy Project’ Lisa Ford, Alieke Van Middelaar, Jennifer Bilton, Alayne Healey, Caroline Ranchhod Acute Allied Health

  2. MSOP Physiotherapy Waitlist Management • Problem background • MSOP waiting list growing • Waitlist targets not being met • Patients are waiting an unacceptable length of time to receive physiotherapy for their condition • Aim Statements for this project • By 31 March 2013, 80% of FSA referrals to MSOP will be seen within the set priority timeframes • By 31 July 2013, 95% of FSA referrals to MSOP will be seen within the set priority timeframes • Priority 1 (P1) = to be seen within 4/52 • Priority 2 (P2) = to be seen within 6/52

  3. Under-utilising other physiotherapy providers Patient consent for referral Accessibility of clinics (evenings / weekends etc) Admin process for booking/scheduling Managing DNA’s and cancellations Triage system Model of care (1:1 vs class) Managing staff leave Wide MSOP referral criteria Referral method (e.g. post, fax, email) Lack of information given on referrals Maximise utilisation of MSOP appointment capacity Reduce the volume of referrals being received and accepted by MSOP service By 31 March 2013, 80% of FSA referrals to MSOP will be seen within the set priority timeframes By 31 July 2013, 95% of FSA referrals will be seen within the set priority timeframes P1 = within 4 weeks P2 = within 6 weeks Driver Diagram Primary Drivers Aims Secondary Drivers

  4. Measures

  5. Change Concepts & Ideas for PDSA’s

  6. Problem: 70 priority 1 patients on MSOP waitlist, 42 waiting >4 weeks ACT: PLAN: Aim of this change: To reduce the Priority 1 waitlist by 30% and “clear the backlog” • The Change: • Priority 1 patients are now be contacted by admin team • by phone • within 1 week of receipt of referral • PFB letter sent when no phone contact possible, 14/7 to respond. • 83% have appointment within 4 weeks • Average wait 2.7 weeks in Feb Measurement % of Priority 1 referrals who did not require appointment and could be removed from waitlist STUDY: DO: Prediction: By telephoning patients we will reduce the Priority 1 waitlist by 30% Contact patients by phone instead of letter as per patient focused booking (PFB) Adopt 55 patients called 39 booked within next 10/7 16 removed from waitlist = 29% Physiotherapist will call all patients to triage and either discharge or book appointment within 2-3weeks

  7. PDSA: Telephone Appointment Scheduling Number of weeks Month / Year

  8. Problem:Insufficient Physiotherapist FTE to meet demand ACT: PLAN: Aim: Improve access to Physiotherapist FSA appointment i.e. within 4/52 for priority 1 patients The Change: Available FSA slots 45-50/week Compared to 30-35 FSA slots/ week in Nov/Dec 2012 Followup patients slots available Non clinical time is preserved SH reduced clinical load Morale boosted! Measurement Number of additional FSA times available STUDY: DO: Prediction:Adding more physiotherapy resource will improve FSA throughput. Adopt. (permanent increase in 0.5 FTE) Recruit to longstanding vacant FTE which had been used for other area in AAH, experienced Physiotherapists, Borrow FTE Fill 2/12 rotator vacancy 16/01/13 – 28/02/13 Additional 134 x 45 minute appointments created F/U patients seen within expected timeframes 16/1/13 - borrow 0.2 FTE 21/1/13 new 0.5 FTE starts & fill 1.0 rotator position

  9. Problem: Priority 2 waiting list numbers are increasing and length of wait >12 weeks ACT: PLAN: Aim of this change: Improve waiting time for Priority 2 referrals to 6-10 weeks The Change: Measurement STUDY: DO: Prediction: Telephone triage of priority 2 patients will reduce waitlist by 60% Contact patients by phone Instead of letter as per patient focused booking (PFB) due to short timeframes from referral to appointment Adopt February 2013; Physiotherapist will call Priority 2 patients waiting since 1/10/12 to triage and either discharge or book appointment within 4 weeks P2 = 239 75 contacted by phone 15 Removed from waitlist = 20% (6% of totalP2 waiting)

  10. Re-defining MSOP Referral Criteria Number of Referrals Accepted Month / Year

  11. Current Referral Trends Number of Referrals Accepted Month / Year

  12. Process Changes and Results Percentage Month / Year

  13. Process Changes and Results Percentage Month / Year

  14. Profound Knowledge Worksheet 14

  15. TEAMWORK & Sustainability of gains to-date Stats available weekly for closer monitoring Closer look at capacity/week+ Recruitment!! FSA as classes vs individual appointments Priority 2 phone triage strategy FOCUS to achieve 80% of referrals seen within timeframes by 31/7/13 Where to from here?

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