Eastern Health, Level 2/5 Arnold Street, Box Hill, VIC, 3128, Australia.
La Trobe University, Kingsbury Drive, Bundoora, VIC, 3086, Australia.
BMC Med. 2018 Oct 19;16(1):182. doi: 10.1186/s12916-018-1170-z.
Long waiting times are associated with public community outpatient health services. This trial aimed to determine if a new model of care based on evidence-based strategies that improved patient flow in two small pilot trials could be used to reduce waiting time across a variety of services. The key principle of the Specific Timely Appointments for Triage (STAT) model is that patients are booked directly into protected assessment appointments and triage is combined with initial management as an alternative to a waiting list and triage system.
A stepped wedge cluster randomised controlled trial was conducted between October 2015 and March 2017, involving 3116 patients at eight sites across a major Australian metropolitan health network.
The intervention reduced waiting time to first appointment by 33.8% (IRR = 0.663, 95% CI 0.516 to 0.852, P = 0.001). Median waiting time decreased from a median of 42 days (IQR 19 to 86) in the control period to a median of 24 days (IQR 13 to 48) in the intervention period. A substantial reduction in variability was also noted. The model did not impact on most secondary outcomes, including time to second appointment, likelihood of discharge by 12 weeks and number of appointments provided, but was associated with a small increase in the rate of missed appointments.
Broad-scale implementation of a model of access and triage that combined triage with initial management and actively managed the relationship between supply and demand achieved substantial reductions in waiting time without adversely impacting on other aspects of care. The reductions in waiting time are likely to have been driven, primarily, by substantial reductions for those patients previously considered low priority.
Australian New Zealand Clinical Trials Registry ACTRN12615001016527 registration date: 29/09/2015.
长等待时间与公共社区门诊卫生服务有关。本试验旨在确定基于两项小型试点试验中改善患者流程的循证策略的新型护理模式是否可用于减少各种服务的等待时间。特定及时分诊预约（STAT）模式的关键原则是，患者直接预约到受保护的评估预约，分诊与初步管理相结合，作为替代等待名单和分诊系统的方法。
2015 年 10 月至 2017 年 3 月期间，在澳大利亚一个主要大都市卫生网络的 8 个站点进行了一项阶梯式楔形集群随机对照试验，涉及 3116 名患者。
干预措施使首次预约的等待时间缩短了 33.8%（IRR=0.663，95%CI 0.516 至 0.852，P=0.001）。在对照组中，中位等待时间从 42 天（IQR 19 至 86）中位数降低到干预组的 24 天（IQR 13 至 48）中位数。还注意到变异性的大幅降低。该模型对大多数次要结果没有影响，包括第二次预约的时间、12 周内出院的可能性以及提供的预约次数，但与错过预约的比例略有增加有关。
广泛实施一种结合分诊与初步管理并积极管理供求关系的获取和分诊模式，可以大幅减少等待时间，而不会对护理的其他方面产生不利影响。等待时间的减少可能主要是由于先前被认为优先级较低的患者的等待时间大幅减少所致。
澳大利亚新西兰临床试验注册 ACTRN12615001016527 注册日期：2015 年 9 月 29 日。
