Jan. 9, 2012

For a patient referred to a medical specialty clinic, the wait for a consultation appointment can often be lengthy, frustrating and anxiety-ridden. But clinics at Women’s College Hospital (WCH) have set out to change that. They’ve created a wait time strategy to allow more patients to be seen quickly and more effectively. At the forefront is the multidisciplinary osteoporosis program, where team members launched a triage project in April 2010. Medical director Dr. Sandra Kim, manager Lynn Carter, clinic secretary Courtney McLean, clinical nurse specialist (CNS) Ina Radziunas successfully reduced wait times by nearly half, while increasing new consultations by 40 per cent. The change isn’t just in the numbers, however. The new program has seen a remarkable increase in patient satisfaction as well.

“Patients are noticing and appreciating the benefits of the change,” says Radziunas. “They are coming to us and commenting on how great their experience with the clinic is – how quickly they received an appointment and were seen after the initial referral. They’re also less anxious and feel better about their health and the treatment they receive, so they share that information with their friends, family and physicians, leading to an increase in program referrals. It’s amazing how doing something so simple can have such a positive impact.”

To achieve these superior outcomes, the project restructured the way new patient referrals were triaged, scheduled and seen at the clinic. First, the team developed a triage tool that determines a patient’s overall risk for osteoporosis-related fracture using clinical risk factors and criteria from the 2010 Osteoporosis Canada Clinical Guidelines. Second, they introduced a new clinic model for patients who are triaged to be at low risk for fractures. In this model patients are assessed only by a physician, CNS and pharmacist, instead of seeing the whole multidisciplinary team. Patients also receive resources to aid them in self-managing their osteoporosis, such as information packages, education workshops, reading materials and links to helpful websites. Collectively, these two changes work to ensure patients receive timely care that reflects their risk factors and referral urgency.

“We began to identify that for many patients who were classified as low risk for fracture, being assessed by the full multidisciplinary team was not the most efficient or effective method of care delivery. For some of these patients it may have actually increased their anxiety,” says Radziunas. “Some seemed to interpret that the greater the number of health-care providers that they had to see during their initial appointment, the more serious their osteoporosis must be. We had a number of low-risk patients believing that they were actually at a higher risk of fracture and needlessly worrying. This is an outcome we’re able to avoid with the implementation of the new model.”

So with the success of this project, what’s next for the multidisciplinary osteoporosis team?

“We will continue to strive to find ways to deliver high quality, patient-centred care,” stresses Radziunas. “Because many of our patients are in a more mature age group and/or living out of town, we are currently looking at different methods of improving access to care. In the future, we hope to use the latest innovations to make bone health updates and education fully accessible to our patients without them having to physically come to WCH – an advancement that will continue to change the way our patients view osteoporosis treatment and management, for the better.” 

The multidisciplinary osteoporosis team: (left to right) Lynn Carter, Courtney McLean, Dr. Sandra Kim and Ina Radziunas