FC39: Quality Improvement to Manage Long Wait Lists in an Ambulatory Geriatric Mental Health Program

Abstract

Background: The COVID-19 pandemic resulted in reduced patient access and deferral of medical services. Long wait times for patients to access specialized medical care became a challenge to health care systems. Baycrest is an academic health sciences centre in Toronto, Canada, that specializes in post-acute and ambulatory care for older adults. As a result of deferred care, wait times for the mental health services increased significantly. This compelled the ambulatory mental health program to apply quality improvement Methods to identify and prioritize care for the most unwell people on the waitlist, while avoiding duplication of referrals between hospitals. This study aimed to assess the utility and feasibility of this new process.

Methods: The quality process involved a Rapid Design Event approach, where the mental health programs created inclusion and exclusion eligibility criteria and established a priority system to assign patients to one of three categories based on need: high priority, routine, and decline. Identification of high priority referrals was meant to allow the most unwell patients to be seen sooner. The central navigation process was refined through quality improvement huddles and standard feedback mechanisms. After three weeks of trialing the process, a sustainability plan to move to operations was applied, and results were continuously monitored through reports and improvement board huddles.

Results: In the first 3 months of implementation, the percentage of patients receiving meaningful clinical contact within 14 days of referral increased from 3.8% to 82.3%, with contact by a clinician within an average of 4 days. Across the ambulatory mental health programs, wait times for psychogeriatric assessment for high priority patients improved from 141 days to 31.8days. Factors leading to the improvement will bediscussed.

Conclusions: The central navigation and extended triage processes were found to be feasible and of great utility. The high priority patients who needed to be assessed sooner were identified through an extended triage process. Meaningful clinical contact was made within days and wait times reduced for those most in need. This demonstrated how a quality improvement process can lead to significant improvements in health care delivery.