1. Improving Occupational Therapy (OT) waiting times
Implementation of a telephone triage system (OTTTrS)
J Harkess, C Mitchell, F Tweedie, J Gibson, Fife Rheumatic Diseases Unit.
BACKGROUND
• Annual increases in referrals to FRDU OT
including a 20% increase in referrals in 2007-
2008.
• Long waiting times experienced by patients
(at an average of 11 weeks for routine pa-
tients 2006-2008).
• Early aggressive therapy in Fife
- some patients fully independent and did
not want/need OT.
- more patients able to work and resume leisure
activites but need support to do this .
- proportionate increase in non complex cases.
Plan Do Study Act (PDSA)
PLAN:Method
Review of services
with staff :
• Waiting times - we antici-
pated an increase in waiting times due to the
ongoing increase in OT
referrals
• Capacity & capability - need to manage current
and future service provision in light of national
demographic trends - both an ageing workforce
and general population.
• Need to continue to be responsive - continue
change of OT focus from just ADL to include
more vocational & leisure rehabilitation, and,
other health promotion activities.
ACT: Conclusion
Following implementation of the telephone triage system
there was a:
• 40% decrease in routine waiting times.
• 68% reduction in the numbers of patients on waiting list
• 23% increase in service capacity (equivalent to employing
a 0.6 wte OT).
2 3 % i nc r e a se i n se r v i c e c a pa c i t y
0
500
1000
1500
2006-2008 2008-2010
pr e/ post t el ephone t r i age
& extr a ski l l mi x
number s
r ef er r als(mean)
new
attendances(mean)
r eview
attendances(mean)
total attendances
4 0 % de c r e a se i n me a n r out i ne wa it i ng
t ime s
0
10
20
2006-2008 2008-2010
p/ post T T & ext r a ski l l
mi x
weeks
waitingtimes-
ur gents (mean)
waitingtime-
r outines (mean)
DO: Primary Intervention
We implemented a telephone triage system (OTTTrS)
• To help screen out people not wanting/needing OT
• To determine the nature of any functional problem(s), and,
the best staff member and course of action for that patient.
Secondary Intervention
• We recruited an additional Rehabilitation Assistant (12hrs) to
assist with the increase in less complex cases.
Telephone Triage System (OTTTrS)
PDSA Cycle
Patient sent telephone appointment
(if not appropriate, home visit arranged)
OT initial telephone interview to establish if
occupational performance problems through
OT screening interview
If problem(s) If no problems
OT telephone advice
OT home /work visit
to further assess and/
or intervene.
Rehabilitation assistant
input for non complex
interventions
Telephone re-
view in 3 months
when stable on
medication/ dis-
charge if patient
does not want/
need OT
STUDY: Results
One hundred and ninety eight (55%) patients were selected for a telephone 1st contact
instead of a visit. Routine waiting times decreased by 40% from 11 wks to 6.5 wks.
The number of patients waiting decreased by 68% from 82 to 26. The additional Reha-
bilitation Assistant allowed for increased direct delegation to this staff group for less
complex interventions. Overall service capacity increased by 23% allowing more new
patients to be seen, and, vocational and leisure rehabilitation to be developed .
Limitation
No data was collated on where ‘no OT required’ or how many were triaged directly to
the Rehabilitation Assistant. This data needs to be captured in the future.
pa t i e nt s wa i t i ng
0
20
40
60
80
100
2006-2007 2007-2008 2008-2009 2009-2010
year
number
of
pat i ent s
number s
waiting
Tot a l ne w a ppoi nt me nt s-
v i si t s:t e l e phone 2 0 10
198, 55%
161, 45%
telephone
visits
Ref er rals
0
2 0 0
4 0 0
6 0 0
2 0 0 5 -
2 0 0 6
2 0 0 6 -
2 0 0 7
2 0 0 7 -
2 0 0 8
Ref err als