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2021-08-25

Inter-Professional Phone Consults: Enhancing connectivity between primary and specialty care as the solution to specialist wait times.

Growing Waitlists in Canada 

Long wait times for specialist consultation have been well documented in Canada. The median time from referral by a primary care practitioner to specialist intervention in Canada is 22.6 weeks. The length of the wait time for specialist consultation has increased by 184% between 1993 and 2020.[1]  

There is variation between provinces in these numbers. The Atlantic provinces have median wait times that are the highest in the country at over 40 weeks, while Ontario and Quebec cite wait lists that are half the length, at 17.4 and 18.8 weeks respectively.  

Within provinces, the wait times can vary across different specialties. In Nova Scotia, a province with some of the longest wait times in the country, government published wait times for outpatient specialty care range from 6 months to over one year.[2] 

The Impact of Long Wait Times 

Long wait times have serious consequences on individuals and society as a whole. Long waiting times have been shown to be associated with patient dissatisfaction, delayed access to treatments, poorer clinical outcomes, increased costs, and increased mortality. [3] In certain instances wait times can lead potentially reversible illnesses or injuries turning into chronic conditions with permanent disability. In these cases, patients may be unable to work, leading to financial strain and reduced economic productivity.  

The Key Role of Primary Care 

While patients sit on wait lists, the responsibility for their care falls on primary care practitioners. However, given that the primary care clinician has referred the patient to a specialist suggests that the patient’s needs are out of the primary care clinician’s scope of care. This mismatch between a patient's clinical needs and the immediately available resources is an unfair source of burden on primary care clinicians. 

Bringing Specialist Expertise into Primary Care 

Over 40% of patients who require specialist input on their care do not require a face-to-face consultation with a specialist but can be addressed through peer-to-peer consultation between the family physician and specialist. [4] These ‘Hallway’ consults have been a longstanding feature of medicine, but with care increasingly being moved from hospitals into disconnected outpatient clinics spread throughout communities, the opportunity for physicians physically crossing paths has become an uncommon event.  

Barriers to Interprofessional Communication 

Modes of physician-to-physician communication are haphazard. Text messages, emails, faxes, phone calls or messages left at the front desk are routine methods of one physician trying to contact another. However, these unsystematic approaches inevitably lead to missed calls, lost faxes, and messages that are never returned. The result can be a never-ending game of phone tag. Physicians spend hours of time trying to connect with each other, when all that is required is a few minutes.  

Technological Innovation 

The healthcare Industry has been slow to adopt new technology aimed at improving clinical workflows. Identified reasons for sluggish adoption include multiple stakeholders with competing interests, funding problems, and government regulation. [4] However, in recent years, as technological innovation has evolved and adapted to clinic a workflow while meeting stringent regulatory requirements, adoption of healthcare technology has accelerated.    

From Many Steps to One Step 

Historically, the referral process involved many steps. The family physician would see the patient and decide that a referral was necessary. They would then complete a generic referral form and most commonly fax it to the specialist. The specialist would review the referral and if it had incomplete information would send it back to the family doctor for revision. If the referral form was acceptable, the appointment would then be booked, typically by arranging a time by phone for the appointment to happen. Each of these steps takes time. Processes with more steps introduce more potential for error. The result is suboptimal care for patients.  

Technological innovation now permits these multistep processes to be simplified. No longer do referrals need to be detached from appointment bookings. And no longer do family physicians need to guess what information is relevant to a specialist when making a referral. Process integration allows pulling complex operations into a single step. Using technology to simplify workflows can increase clinician time, and improve efficiency in the referral process. Introducing technological innovation to improve clinic process can allow physicians to more effectively communicate and improve outcomes for patients.    

[1] Barua B, Moir M. Waiting your turn, wait times for health care in Canada, 2020 report.  Fraser Institute, 2020. Available from:https://www.fraserinstitute.org/sites/default/files/waiting-your-turn-2020.pdf 

[2] Nova Scotia (2021, August 16).  Nova Scotia Health Care Wait Times.  https://waittimes.novascotia.ca/procedures/internal-medicine-referrals-interventions 

[3] McIntyre D, Chow CK. Waiting Time as an Indicator for Health Services Under Strain: A Narrative Review. INQUIRY: The Journal of Health Care Organization, Provision, and Financing. January 2020.   

[4]Herzlinger R. Why Innovation in Health Care Is So Hard. Harvard Business Review, 2006. Why Innovation in Health Care Is So Hard (hbr.org) 

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