British Columbians don’t have enough gastroenterologists or endoscopy resources.
And that leads to long wait times, says Dr. Jennifer Telford, who is with Pacific Gastroenterology Associates and is part of St. Paul’s Hospital’s Gastroenterology Division.
She and a team received funding from the Specialist Services Committee, a partnership of the BC government and Doctors of BC, to investigate the situation, then find a way to reduce wait times and treat the most urgent cases first.
The average provincial wait time for gastroenterology care is about 200 days, while wait times for urgent GI problems like active inflammatory bowel disease could average 87 days after a referral. That compares to the benchmark of just 14 days.
For patients waiting for endoscopic procedures at St. Paul’s Hospital, only seven per cent meet Canadian Association of Gastroenterology (CAG) wait-time guidelines for urgent or semi-urgent cases.
“These wait times will mean more emergency room visits to manage symptoms,” says Dr. Telford. “And critical diagnoses of inflammatory bowel disease will increase the likelihood of hospital admission.”
Meanwhile, the delay in a cancer diagnosis increases mortality.
In light of this, Dr. Telford and her team have devised a prototype model of gastroenterology care for patients referred to specialists by their family doctors.
It involves a pooled referral system for all patients and a triage to send people to the first available and appropriate gastroenterologist for outpatient consultation.
Based on the findings, she proposes:
Developing an electronic referral and triage tool with input from stakeholders, including the Clinic’s 11 gastroenterologists, medical office assistants, and family physicians. The referral form will be populated into the referring physician’s electronic medical records with the intake and triage performed within the Pacific Gastroenterology EMR.
The screening of referrals by a trained health care worker to appropriately book patients with the first available and appropriate gastroenterologist. The goal is that patients will be booked within the appropriate timeframe depending on their condition, according to consensus guidelines.
Recording of all project data in a database to allow a comparison between a pooled referral model vs. the current care model. Wait-times will be monitored in the clinic’s EMR.
Telford believes the prototype will improve the patient care experience and decrease the number of emergency room visits and hospitalizations.
She says her team will be able to compare the cost of excess health care use in the current care model to the cost of her prototype.
Dr. Telford expects the rollout to begin in June 2018