Sustainability of an intervention to reduce waiting for access to an epilepsy outpatient clinic

Annie K Lewis; Nicholas F Taylor; Patrick W Carney; Alexander Bryson; Moksh Sethi; Suyi Ooi; Gabrielle T Tse; Katherine E Harding

doi:10.1016/j.heliyon.2023.e23346

Sustainability of an intervention to reduce waiting for access to an epilepsy outpatient clinic

Heliyon. 2023 Dec 10;10(1):e23346. doi: 10.1016/j.heliyon.2023.e23346. eCollection 2024 Jan 15.

Authors

Annie K Lewis^{1

2}, Nicholas F Taylor^{1

2}, Patrick W Carney^{1

3

4}, Alexander Bryson^{1

4}, Moksh Sethi^{1

5}, Suyi Ooi^{1

4}, Gabrielle T Tse¹, Katherine E Harding^{1

2}

Affiliations

¹ Eastern Health, Melbourne, Australia.
² La Trobe University, Melbourne, Australia.
³ Monash University, Melbourne, Australia.
⁴ The Florey Institute of Neuroscience and Mental Health, Melbourne, Australia.
⁵ Northern Health, Melbourne, Australia.

Abstract

Purpose: Delays in outpatient specialist neurologist care for people with epilepsy are common despite recommendations for prompt access. There is evidence to suggest that there are interventions that can minimise waitlists and waiting time. However, little is known about whether such interventions can result in sustained improvements in waiting. The aim of this study was to determine the extent to which an intervention to reduce waiting in an epilepsy specialist outpatient clinic demonstrated sustained outcomes two years after the intervention was implemented.

Methods: This observational study analysed routinely collected epilepsy clinic data over three study periods: pre-intervention, post-intervention and at two-year follow-up. The intervention, Specific Timely Assessment and Triage (STAT), combined a short-term backlog reduction strategy and creation of protected appointments for new referrals based on analysis of demand. After the initial intervention, there was no further active intervention in the following two years. The primary outcome was waiting measured by 1.) waiting time for access to a clinic appointment, defined as the number of days between referral and first appointment for all patients referred to the epilepsy clinic during the three study periods; and 2.) a snapshot of the number of patients on the waitlist at two time points for each of the three study periods.

Results: Two years after implementing the STAT model in an epilepsy clinic, median waiting time from post-intervention to two-year follow-up was stable (52-51 days) and the interquartile range of days waited reduced from 37 to 77 days post-intervention to 45-57 days at two-year follow-up, with a reduction in the most lengthy wait times observed. After a dramatic reduction of the total number of patients on the waitlist immediately following the intervention, a small rise was seen at two years (n = 69) which remained well below the pre-intervention level (n = 582).

Conclusion: The STAT model is a promising intervention for reducing waiting in an epilepsy clinic. While there was a small increase in the waitlist after two years, the median waiting time was sustained.

Keywords: Access; Demand management; Epilepsy; Outpatient clinic; Sustainability; Waitlist.