No study yet on farming out outpatients specialties to cut waiting times

Mater Dei Hospital says it is as yet unable to farm out some of its specialties to health centres and other government institutions to reduce outpatients waiting lists, because no studies have yet been carried out on the proposal.

The hospital had been advised by the National Audit Office to consider contracting outpatients services through public-private partnerships to decrease waiting times.

But a cost-benefit analysis to see whether farming out and PPPs would be justified has not yet been carried out, an NAO follow-up has established.

In 2017, Mater Dei was exploring which outsourcing of outpatient clinics would contribute to the reduction of patient waiting times. Outpatient clinics under consideration included Urology, Rheumatology, Respiratory, Diabetes and Gastroenterology.

However, after various discussions between the main medical stakeholders and committee members, it was decided that such a proposal was not feasible and so was put on hold. This was mainly due to infrastructural limitations within the private sector and the unfeasible cost structure proposed.

MDH had also considered the option to farm out some of its specialties to health centres or other government institutions.

“Up to the writing of this Report, MDH contends that farming out outpatient appointments may be a slow process as well as low in numbers. This is due to the need of setting discharge criteria as well as re-appointing criteria.

“MDH [is] still discussing the establishment of outpatient discharge and appointment criteria and how this could be validated in a farming out scenario. To date, MDH has not carried out or commissioned any studies in this regard.”

The original NAO audit had found that the average patient waits more than eight months for their first outpatient appointment at Mater Dei.

The state hospital’s 250-day waiting time average was double that in the UK and seven weeks longer than what Irish patients endure. Mater Dei receives roughly half a million outpatient visits every year, at an annual cost of approximately €32 million to taxpayers. That figure boils down to an average of €3.18 per minute for each consultation visit.

Anything between 20 and 50 per cent of the annual 500,000 outpatient visits, for instance, were considered unnecessary by senior clinicians and could have been handled by regional healthcare centres. Had such inappropriate referrals been caught in time, waiting times in specialisations such as genetics and neurology could have been halved, the study found.

The hospital has also yet to fully implement an electronic system publishing real-time information relating to the waiting times for different consultants.

The system, which could be in place in 2020, would allow patients together with their referring practitioner to make more informed decisions regarding their care.

Mater Dei is also in the process of identifying and establishing key performance indicators (KPIs) on waiting times intended to further motivate the clinicians to reduce patient waiting times at the Outpatient Department.

Despite text reminders, 22% don’t turn up for hospital appointments

The introduction of a text messaging reminder system has only reduced the non-attendance rate for outpatient appointments from 30% to 22%, a study published in the Medical Journal back in April shows.

Despite the decrease in no-shows since the introduction of the SMS system in 2017, the non-attendance rate remains “disturbing and continues to negatively influence Mater Dei’s logistical and operational arrangements and increase waiting times”.

The authors of the study called for improvements to the way patients’ mobile telephone numbers are added to the hospital‘s electronic database, saying that 39% of patients who did not attend appointments insisted they never received the text reminder.

It is estimated that the average cost to provide a consultation visit as an outpatient is around €3.18 per minute, depending on the speciality.
They are also suggesting that when patients call to reschedule their appointments, the cancelled appointment should be re-allocated to improve efficiency of the clinic.

The study was based on attendance rates at four surgical outpatients’ clinics where the total number of appointments were documented over a period of a month. Non-attenders were contacted via a telephone call and asked to explain their non-attendance as well as being asked if they had received a text-message reminding them of their appointment.

Out of a total of 227 appointments (205 females, 22 males), 49 patients did not turn up, representing a 22% non-attendance rate.

Out of these 49 patients, 41 answered their phone and were interviewed for this study. The rest were not reached because a contact number was not in their physical and electronic records (2 patients) or they did not answer their phone at all (6 patients).

Out of the 41 contacted, 16 (39%) claimed they did not receive a text message reminding them about their appointment, whilst acknowledging that they all have a functional mobile phone and they know how to receive and read a text message.

While recognising the possibility that some of these patients may have forgotten or were reluctant to own up, the authors insist that this should “raise an alert” that the hospital needs to keep mobile telephone numbers updated on the electronic records system. “Wards and outpatient clerks should be reminded to update these records after every patient visit. It might also be possible to share a database with telephone service providers if this does not contravene data protection legislation.”

Significantly only 39% of all the non-attendees contacted the surgical outpatients department beforehand and postponed their appointment to another date. 22% (9 patients) did not know at all about the appointment and 12% (5 patients) forgot completely about the appointment.

Seven patients knew about their appointment but they could not make it and did not inform anyone.