The Central Okanagan Division of Family Practice (COD) engaged in dialogue with its members, local gastroenterologists and IH Ambulatory Care Managers at Kelowna General Hospital (KGH) and identified an opportunity to improve the referral and wait-time management process for endoscopic procedures.
Further discussion with the Kelowna Gastroenterology (GI) department determined a pressing need to address communication between family practice offices and GI services. The scope of this project was limited to gastroenterologists, family practice and the KGH Ambulatory Care GI lab.
This work coincided with KGH Ambulatory Care GI wait-time work already in progress. A collaborative GI Steering Committee was formed. The COD, family physicians, GI specialists, and KGH Ambulatory Care worked together in order to improve the health system process of referral and waitlist management for endoscopic procedures. Work on this project commenced with the goal of providing timely access to GI care. Three key issues were addressed:
unknown wait times for GI services
unknown wait times for diagnostic endoscopy at KGH
incomplete referrals received by GI offices
The intended outcome was to address the existing backlog, streamline the referral process, and to improve communication between Family Physicians and Gastroenterologists. The ultimate goal was to reduce patient wait times for GI appointments and procedures.
The steering committee identified that incomplete / inappropriate referrals were impeding the ability of the GI Clinic to accurately triage incoming referrals. Gastroenterologists, family doctors and the Manager of Ambulatory Care co-developed a referral form based on best evidence to align referrals to gastroenterology with supporting diagnostics and/or information that enables gastroenterologists to assess urgency level.
Gastroenterologists and KGH Ambulatory Care Management reviewed national and provincial documents to identify benchmark targets for GI conditions. A new booking form was developed by KGH Administration which utilizes BC Surgical Patient Registry codes and their associated wait time targets.
The new GI Referral Form was piloted by 41 Family Physicians as part of field test held April/May 2013. A Feedback Form was developed for use by Gastroenterologists to assess whether there was sufficient information to accurately triage patients within the guidelines. The field test compared referrals from Family Physicians who used the new Referral Form and those who did not. GI Associates Office Manager coordinated collection of information from 3 Gastroenterologists involved in the field test. A total of 110 referrals were reviewed; 52 referrals used the new GI Referral Form and 58 referrals were sent in the typical manner of a referral letter/fax.
The results of the field test were entered into excel and analyzed. An online survey was developed, pretested and disseminated to the 41 Family Physicians who agreed to trial the Form. 11 Family Physicians completed the survey (27% response rate). Key Informant interviews were conducted with 3 Family Physicians, 2 Gastroenterologists, the Office Manager of GI Associates and the Ambulatory Care Manager.