Service redesign for outpatient services: Strategies to improve the wait

Objective: To assess the effectiveness of a multicomponent waitlist optimisation strategy on the proportion of patients overdue to be seen for a neurosurgical (spinal pain) outpatient service at an Australian public hospital. Study design: An interrupted time series study in the outpatient department of a tertiary referral hospital in New South Wales, Australia. Methods: We implemented and evaluated nine waitlist optimisation strategies. We compared a Pre-implementation phase (January 2015–January 2016), a Implementation phase (February 2016–December 2017), and a Post-implementation phase (January 2018–January 2020). We included data from all adults who had been referred for neck and back pain. We used three outcomes of interest; they were: (i) the proportion of patients overdue to be seen (based on their triage category) for a given month, (ii) the proportion of patients that were waiting longer than one year for an initial appointment each month and (iii) the total neurosurgical waitlist number. Results: We included data from 11,520 unique individuals who had a mean age of 54 years (SD 17), 51 % (5900) were female, and 8·8 % (1004) identified as Aboriginal and/or Torres Strait Islander. Across the three phases, there were 26,928 monthly data points Pre-implementation, 36,009 Implementation, and 15,326 Post-implementation. The trend in the proportion of patients overdue to be seen in the Post-Implementation phase was 7 % lower (OR 0·93 [95 % CI 0·89, 0·97]) compared to Pre-implementation. Conclusion: The waitlist optimisation strategies tested in this study led to a large reduction in the proportion of patients overdue to be seen on the neurosurgical waitlist. The tested strategies can be used by other services to address extended waits in outpatient services.