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New system for booking endoscopies aims to shorten wait times

New system for booking endoscopies aims to shorten wait times

BY MIKE DALY
Winnipeg Health Region
Wave, January / February 2016

Winnipeggers can expect to benefit from a new central booking system designed to cut wait times for endoscopies.

By the end of February, physicians will be able to book endoscopies for their patients through a unified scheduling system known as Central Intake.

An endoscopy is a non-surgical, diagnostic procedure that uses a flexible tube with a light and camera attached to it to examine portions of a person's digestive tract. Gastroscopies, colonoscopies and sigmoidoscopies are all considered endoscopies and are carried out by specialists.

The new system, spearheaded by the Winnipeg Health Region, Manitoba Health, CancerCare Manitoba, and the Departments of Medicine and Surgery at the University of Manitoba, flowed from an ambitious re-evaluation and redesign of endoscopy services within the Region. In addition to shortening wait times, the new booking system is expected to:

  • Ensure patients are getting the right test for the right indication.
  • Improve communication, record keeping and continuity with patients and referring physicians.
  • Ensure adequate and fair distribution of endoscopic resources within the Region.

There are approximately 30,000 endoscopies conducted annually within the Region. Most are performed at one of the city's six hospitals: Health Sciences Centre Winnipeg, St. Boniface Hospital, Grace Hospital, Seven Oaks Hospital, Concordia Hospital and Victoria Hospital.

The central intake model, which can be described as a shared, centrally administered process for the handling of medical consultations and referrals, offers an effective means to reduce wait times and improve efficiency.

"The perception within the health-care system is that wait lists for endoscopy services are incredibly long, but that's not entirely accurate," says gastroenterologist Dr. Dana Moffatt, Medical Director of Endoscopy Services for the Region.

"What we've found is that wait lists for a particular specialist may be long, but overall, we have the capacity to shorten wait times by more effectively allocating our available resources. In other words, it's mainly an administrative challenge, and not just a lack of resources."

Prior to the creation of the Central Intake office for endoscopies, the standard procedure was for physicians to refer their patients to an endoscopist without central oversight or assistance. But with dozens of endoscopists offering services in multiple sites across Winnipeg, it was all but impossible for those physicians to see where scheduling bottlenecks might occur. 

As Moffatt explains, "Your family doctor thinks they are doing you a favour by sending you to a well-known endoscopist, or one with whom they have a long-standing relationship. Meanwhile, you might have been seen much sooner had your doctor been aware there was another qualified endoscopist available. Through no fault of the physicians, that's led to huge imbalances in wait times. One patient might be scheduled in a week, and another might have to wait a year. And that's a problem if you're a patient."

By centralizing the referrals, triage, and booking functions in a single office - and by standardizing the information given to patients to help them prepare for their endoscopy appointments - significant gains can be achieved, says Carrie Loewen, Manager of Central Intake, Regional Endoscopy Services.

"Imagine if you were asked to choose the fastest teller at a bank. From your vantage point, you really can't see if the teller you've chosen will be tied up for an hour with a customer who has 16 different interactions. But if the bank has a system where everyone in line can be routed to the next available teller, you'll get faster service. Essentially, that's what a central intake office is all about. By handling all of the administrative functions out of a single office, we get a better overall view on how we can make the most efficient use of our available resources. Wait times are reduced. And if a patient wants to wait for a specific endoscopist, that's fine, too."

HSC, St. Boniface, Grace, and Seven Oaks are already using the services of Central Intake, with Concordia and Victoria hospitals expected to move to the new system by mid-February.

Moffatt credits Dr. Dan Roberts and surgery program directors Mary Anne Lynch and Lanette Siragusa for seeing the need for improvement, and for suggesting the Central Intake model as the most effective path forward. In his capacity as Medical Director of the Region's Medicine Program, Roberts has led a number of efforts to enhance the delivery of care, including the creation of the first Critical Care Database in Canada and a city-wide, integrated adult intensive care service. More recently, he led an initiative to ensure patients do not stay in hospital longer than medically necessary. All these efforts helped enhance access to care and improve efficiencies in the system.

Moffatt says most health-care organizing bodies, including the Canadian Medical Association and the Royal College of Physicians and Surgeons of Canada, are recommending that centralized booking systems be adopted to reduce wait times for specialists. Central Intake offices are being used in the Region for hip and knee replacement, diagnostic imaging services and with the Region's Home Care program, among others.

The main difference in setting up Central Intake for endoscopy services was the complexity of the project, says Linda Hathout, Senior Process Engineer with the University of Manitoba's Department of Internal Medicine.

"To get 51 physicians and surgeons on board - each with specific variations on how they conducted their business or communicated with patients - took a great deal of discussion. There were some strong feelings on how best to proceed, so it took a great deal of evidence-based documentation and consensus-building. Throughout it all, we were guided by a single, overriding principle: to try to increase patient access to the right tests with the right consultants in the best possible timeframe. We feel we're now in a position to achieve that goal."

Mike Daly is a communications specialist with the Winnipeg Health Region.

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