The Power of Partnership, Measurement, and Data: Countering the Challenge of Ballooning Specialist Referrals and Wait times
Daniel Rivera, Combined BScH/MSc Candidate, Life Sciences/Neuroscience
The January 16th Medical Grand Round was fortunate to host Dr. Mark Swain who is currently the Head of the Division of Gastroenterology and Hepatology at the University of Calgary.
Dr. Swain spoke of the power that partnerships and measurement played in his experience combatting ballooning wait times for GI specialist appointments in Calgary – a problem arising from ever-increasing demand amidst a limited amount of specialist availability.
Gastroenterology was amongst the most referred-to specialties in Calgary in the early 2010s, with wait times often as long as 2 years. Dr. Swain spoke of his intention to harness the power of measurement, which he was well acquainted with as a clinician-scientist, to combat this issue upon assuming the role of Division Head in 2012.
Key to success would be partnering with primary care physicians (PCPs). With many patients being referred to GI specialists without “red flags” such as weight loss, rectal bleeding, or anemia, significant strain was placed on the wait list. This led to frustration for PCPs, patients, and specialists alike. To combat this, Clinical Care Pathways were developed jointly with PCPs to help identify the most appropriate, evidence-based type of care given a patient’s clinical presentation. These were made publicly available to physicians and patient’s alike and can be found on the Calgary Division of Gastroenterology and Hepatology’s website so both parties are able to better understand the journey from primary care onwards regarding gastrointestinal symptoms.
Key to effective entry and utilization of a Clinical Care Pathway is, as Dr. Swain asserted, effective triage. In Calgary, GI Central Access and Triage (CAT) was established and allowed for priority to be placed on the sickest patients but also for patients with less urgent symptoms to be led on more appropriate clinical care paths. As many as 40% and 15% of patients reporting abdominal pain have indigestion (with or without gastric reflux) or irritable bowel syndrome, respectively. These disorders are often effectively remedied by lifestyle and dietary adjustment and are best handle by non-specialist care. Specialist care, it seems, may not always be the best, or most appropriate, care. Dr. Swain presented data showing that 84% of patients led to primary care via CAT had their symptoms effectively managed and the 16% who were re-referred to specialists did not present with urgent disorders or disease upon re-assessment. Data and measurement have come to show that smarter approaches to triage and referrals can lead to better outcomes for patients and halt increasing GI specialist referral.
But, strategic partnerships continued to form. Specialist LINK, which seeks to improve PCP and specialist communication was developed with the Division of Gastroenterology and Hepatology, Primary Care Networks, and Alberta Health Services. Specialist LINK is available to all PCPs in Calgary via telephone and promises, upon a call, a call back from a GI specialist within 30 minutes to provide tele-advice and information on the Clinical Care Pathways. The benefits were rapidly recognized by PCPs handling GI symptoms, and this their patients, so much so that Specialist LINK has expanded to 23 specialties to date. Between 2014 and 2019, a 101% increase in the number of patients who avoided a specialist referral was achieved. When surveyed, 89% of PCPs were satisfied with the service and 80% felt better equipped with it. Data also shows that $1.2 million has been saved since between 2014-2019 with that amount projected to increase to $2.0 million in 2020. Measurement and data, again, have proven the effectiveness of strategic partnerships in countering stubborn clinical challenges.
Dr. Swain and other’s efforts show that partnering with all relevant stakeholders can result in the development of solutions to challenges, such as the wait time and referral crisis, that work for physicians and patients alike.
In our post-round discussion, Dr. Swain spoke to the TMED 801 class about how empowering data can be when shared with patients, reflecting on his experiences in hepatology. To provide patients with the appropriate, evidence-based care can profoundly quell the anxiety of experiencing distressing symptoms. Patients feel taken care of, whether the next healthcare step is what they had feared or different from what they expected. To take the right next step, rigorous measurement and data collection is necessary to not only empower the clinician, but also benefit the patient.
It was a pleasure to have Dr. Swain present at Medical Grand Rounds! Thank you for sharing your experience, insight, and time with all those who attended and, on behalf of the TMED 801 students, for the discussion that followed!