Journal Article

The British Columbia Nephrologists’ Access Study (BCNAS) – a prospective, health services interventional study to develop waiting time benchmarks and reduce wait times for out-patient nephrology consultations

Romann, Alexandra, Djurdev, Ognjenka, Levin, Adeera, Beaulieu, Monica, Schachter, Michael E

2013

Overview

Background Early referral and management of high-risk chronic kidney disease may prevent or delay the need for dialysis. Automatic eGFR reporting has increased demand for out-patient nephrology consultations and in some cases, prolonged queues. In Canada, a national task force suggested the development of waiting time targets, which has not been done for nephrology. Methods We sought to describe waiting time for outpatient nephrology consultations in British Columbia (BC). Data collection occurred in 2 phases: 1) Baseline Description (Jan 18-28, 2010) and 2) Post Waiting Time Benchmark-Introduction (Jan 16-27, 2012). Waiting time was defined as the interval from receipt of referral letters to assessment. Using a modified Delphi process, Nephrologists and Family Physicians (FP) developed waiting time targets for commonly referred conditions through meetings and surveys. Rules were developed to weigh-in nephrologists’, FPs’, and patients’ perspectives in order to generate waiting time benchmarks. Targets consider comorbidities, eGFR, BP and albuminuria. Referred conditions were assigned a priority score between 1-4. BC nephrologists were encouraged to centrally triage referrals to see the first available nephrologist. Waiting time benchmarks were simultaneously introduced to guide patient scheduling. A post-intervention waiting time evaluation was then repeated. Results In 2010 and 2012, 43/52 (83%) and 46/57 (81%) of BC nephrologists participated. Waiting time decreased from 98(IQR44,157) to 64(IQR21,120) days from 2010 to 2012 (p = <.001), despite no change in referral eGFR, demographics, nor number of office hrs/wk. Waiting time improved most for high priority patients. Conclusions An integrated, Provincial initiative to measure wait times, develop waiting benchmarks, and engage physicians in active waiting time management associated with improved access to nephrologists in BC. Improvements in waiting time was most marked for the highest priority patients, which suggests that benchmarks had an influence on triaging behavior. Further research is needed to determine whether this effect is sustainable.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V
• Subject: Adult / Aged / Aged, 80 and over / Ambulatory Care - organization & administration / Ambulatory Care - standards / Benchmarking - methods / Benchmarking - standards / Benchmarks / British Columbia - epidemiology / Care and treatment / Central service department / Comorbidity / Data entry / Efficiency, Organizational - standards / Efficiency, Organizational - statistics & numerical data / Family medicine / Female / Guidelines and Policy / Hospitals / Humans / Initiatives / Internal Medicine / Kidney diseases / Male / Medicine / Medicine & Public Health / Middle Aged / Models, Organizational / Nephrology / Nephrology - organization & administration / Nephrology - statistics & numerical data / Organizational Objectives / Participation / Patients / Prevention / Prospective Studies / Referral and Consultation - organization & administration / Referral and Consultation - standards / Renal Insufficiency, Chronic - diagnosis / Renal Insufficiency, Chronic - epidemiology / Research Article / Sensitivity analysis / Studies / Time management / Waiting Lists