Effect of Clinical Pathway Implementation on Outpatient Wait Time to Urgent Specialty Appointment

Abstract

<p>Untoward wait time between a primary care referral and initial urgent specialty care appointment was identified during a root cause analysis at the project facility. Ambiguous role responsibilities and unclear referral processes were reported as contributors to the extended wait time. Care coordination policy has outlined key elements for patient safety improvement during outpatient referral processes. Process standardization and decreased wait times have been reported through pathway utilization in other healthcare settings. A facility-specific pathway was developed utilizing care coordination and clinical pathway principles. The purpose of the quality improvement project was implementation of a clinical pathway to decrease wait time between primary care referral and urgent outpatient specialty care appointment. The project process has been structured with a Plan-Do-Study-Act framework. The effect of pathway implementation on wait time was evaluated by quantitative data. Staff experience with pathway implementation was evaluated by qualitative data. The mean wait time improvement pre-pathway (34.11 days) to post-pathway (28.96 days) was not statistically significant. Yet, further evaluation of same-specialty categories revealed third quartile wait times improved in three out of four subspecialties categories. Development in staff education, primary-specialty relationships, referral order menus, and incorporation of informatics for data monitoring are recommended next-step actions. The project has provided clinically relevant data not previously examined at the project facility. </p>