Innovations to Improve Access
For Central Triage and Access, wait times for the sickest patients (urgent referrals) continue to be a priority, with waits maintained under 6 weeks as a result of adding urgent clinics with matched endoscopy time, and enhanced direct to procedure pathways. However, waits for routine requests continue to be challenging with an average wait of 24 months. Activities aimed at enhancing access for routine referrals include:
- Telephone consultation service: A resource for referring physicians to connect with a GI specialist and gain information for patients who are in the queue. Written materials for patients and clinical care pathways have been developed to help give patients some guidelines while they are waiting to see a specialist.
- Nurse Navigator: Increasing nurse involvement with patients who are waiting to see a specialist. Routine triage patients who do not urgently need to see a doctor are often left with no care while they are in the queue to see a specialist. With increased nurse involvement for GERD, Dyspepsia, and IBS, these patients can now receive help before they see a specialist.
- Direct to Procedure (DTP) optimization: DTP refers to the consultation and endoscopy occuring on the same day. This allows one step in the wait to be skipped, decreasing the wait times for all triage priorities. Scheduled nurse-led follow-up for patients who have undergone DTP will aim to improve follow up care. With physician supervision, this will be led by nurse clinicians and will begin in the fall of 2014.
- Colorectal cancer screening: FIT positive, CCSC ineligible patients for screening. Target wait time 6 weeks through a nurse-based clinic with physician supervision.
- CUPs clinic: Calgary Urban Project Society is a non-profit organization based in the downtown core which provides care for economically disadvantaged individuals, whom often experience difficulty in accessing GI care both in clinic and in endoscopy. A specialty CUPs GI clinic (once monthly) was initiated to improve access and to support the education of patients (January 2014), with provision of teaching materials, free-endoscopy preparation kits and transport post-procedure for patients.
- IBD outreach: support including outreach clinics and telephone consultation is being actively developed for areas with high inflammatory bowel disease (IBD) burden with a lack of GI specialty care (e.g. Medicine Hat). This program is ongoing, in collaboration with primary care and administration, with an aim to improve support for medically complex patients in surrounding areas.