Abstract
Background: The Integrated Care Programme for the Prevention and Management of Chronic Disease in Ireland describes an integrated service across community and acute hospital for patients with COPD/asthma, cardiovascular disease and/or diabetes. Thirty CD CST have been established to provide timely and equitable access to specialist multidisciplinary care at the lowest appropriate level of complexity, in line with Sláintecare, Ireland’s national health policy.
Approach: A quality improvement project was conducted over 6 months with four integrated clinical cardiology sites (CD-CSTs and acute services) to optimise their referral management, triage processes and use of digital technology to deliver a more person-centred service, to improve waiting times for scheduled care and to improve collaboration across General Practice, community and acute services.
Aims of the project were to:
1.Demonstrate a reduction in the number of individuals waiting 12 months or longer for their first outpatient appointment
2.Develop a process by which acute hospitals could identify and refer individuals who were on an outpatient waiting list to the CD-CST where clinically appropriate to support more timely access to care
3.Establish direct GP access services to the CD-CST to support the delivery of the right care, in the right place, at the right time
4.Support the more efficient use of resources
Results: Significant reductions in numbers of patients waiting 12 months or more for specialist input were observed across the four sites, in addition to significant reduction in the wait times for patients to be seen. DNA rates reduced in all sites to <4%. This project has also developed:
- New referral practices which provide transparency in how to navigate the system for GPs & patients.
- Improved collaboration, co-ordination and knowledge sharing across general practice, CD CST and acute teams to deliver person-centred care
- Structured scheduling to manage DNA rates and optimise use of existing resources
Significant GP Engagement as part of the project has created provided positive patient feedback with regard to the services.
Implications: The learning and processes developed from this quality improvement project will be shared across all GPs, CD CSTs and acute hospitals to further progress implementation of end to end integrated cardiology services in line with our MoC in Ireland .These processes can also be replicated across the other specialties respiratory and diabetes. This project has demonstrated the impact of the integrated services on OPD waitlists and wait times but also the importance of collaboration to drive delivery of an integrated service to improve patient outcomes.