Aged Care Assessment Team - Reducing the Waiting List
21 October 2005
North Sydney/Central Coast Area Health Service
This project was a finalist in the Baxter 2005 NSW Health Awards, Access to Services category.
Entries from the Baxter 2005 NSW Health Awards - full list
Presentation from the NSW Health Excellence in Quality and Safety Forum, 21 Oct 2005 (pdf)
Authors
M Long, Hornsby Ku-ring-gai Health Service, NSCCAHS
L Adler, Hornsby Ku-ring-gai Health Service, NSCCAHS
Abstract
The Hornsby Ku-ring-gai Aged Care Assessment Team (ACAT) provides comprehensive aged care assessments to over 3000 older people per annum. The team experiences constant high demand with an average of 65 new referrals each week. At the time of commencing this project there were over 200 people on the waiting list without an allocated case manager and a waiting time of 8 weeks.
The goal was to reduce the actual number of patients waiting for comprehensive assessment, improve external customer satisfaction, improve workflow and optimise clinical resources.
At the end of the first four months ie by September 2004, the ACAT had achieved the following outcomes. 50% reduction in the number of clients waiting. Reduction in waiting time from 8 weeks to 5 weeks. A reduction in the number of phone calls about clients waiting and ACAT staff reported increased satisfaction with the process and the expanded role for occupational therapists.
Aim
To reduce the Hornsby Ku-ring-gai Aged Care Assessment team waiting list by 50% in 12 months
Background
ACAT is a multi-disciplinary team with an to provide comprehensive clinical assessment and care planning for older people with chronic and complex care needs who require additional help to remain independent. In 2004 ACAT had 3104 referrals. Due to the high demand for ACAT services there was growing dissatisfaction amongst clients and referrers due to the long waiting list. In May 2004 the waiting list statistics were 218 clients on the comprehensive assessment waiting list and that waiting list was 8 weeks, Occupational Therapy waiting list was 3 weeks, Medical Officer waiting list was one week and Physiotherapy had no waiting list. The aim of the project was to make improvements in the following areas.
Methodolgy
The increasing ACAT waiting list and waiting times and consequent concerns from customers and staff had been the subject of a lot of team discussion. There was support to try and address this problem and the stretch goal of reducing the waiting list by 50% in 12 months was established at a team meeting in May 2004.
In June a half-day workshop for the whole team was held. Data, informal customer feedback and staff perceptions were discussed.
A flow chart of the current waitlist process was done highlighting the current process being complicated and time consuming which was followed by a brainstorming session where 7 categories were described in a cause & effect diagram.
Once categorised the group voted individually on the areas that they felt if actioned, would reduce the current waitlist. As demonstrated in the Pareto Chart the areas of work practices, allocation and lastly communication were highlighted.
Planning and Implementation
After the half-day workshop a smaller guidance team was then established with the following changes -
- Allocation back to a nominated clinician if they have seen the client in the past 12 months. Therefore the clinician takes ownership and there would be a nominated case manager from the point of allocation as well as improved continuity of care.
- Any client deemed to need an assessment within 4 weeks would be directly allocated to a nominated clinician by the clinical coordinator. Therefore giving the coordinator authority to allocate quickly with better understanding of staff workload.
- Develop criteria for more allocations from the general waiting list to Occupational Therapists who would increase the number of comprehensive assessments they were doing.
- Clients requiring multiple clinician input ie Physiotherapy, Occupational Therapist, Social Worker and Registered Nurse, to be initially allocated to one clinician/case manager who will then make internal referrals/organise joint visits if required.
- Statistics monitored were the number of clients waiting, general waiting list times, number of clients who were directly allocated, Occupational Therapists waiting list. The clinical coordinator gave feedback on the number and type of phone calls regarding the waiting list.
Outcomes and Evaluation
ACAT REFERRALS MAY – SEPT 2004
Referrals
*1st major intervention implemented in May was direct allocation of any client seen in past 12 months back to initial team member & allocation of semi-urgent (ie under 4weeks) direct to rolling roster
**2nd major intervention was increase in OTs doing comprehensive assessments
*** 3rd intervention was no allocation of joint assessments – initial team member arranges for others as required
At the commencement of the project the number of clients waiting without an allocated case manager was 218 and after 4 months this had reduced to 102, just over a 50% reduction.
Summary of Outcomes
- reduction in the waiting time from 8 weeks to 5 weeks
- increase in no. of clients with nominated case manager
- substantial decrease in no. phone calls “complaining” about waiting time
- improved continuity of care for clients and carers
- staff report satisfaction with direct allocation process
- reduction of no. of clients on waiting list by 50%
Six months later the ACAT re-evaluated the data to establish whether gains made had been sustained.
For the four month period from February to May 2005 the same data comparisons were made.
Direct allocation for comprehensive assessment has enabled the waiting list to be kept at around 100 clients waiting and the waiting time remains at approximately 5 weeks. The gains made have been able to be sustained.
Future Scope
Other initiatives implemented include - improving communication both internally and externally by upgrading and increasing computer access via GroupWise & SNAPshot. Plus data base (read only) for better access to recent client contact information. Improved education & information to GP’s on the role & referral process of ACAT.
This project has generated interest from other similar ACATs in NSW. After a brief presentation at a Metropolitan ACAT Forum, two ACAT Managers from Glebe and Concord visited Hornsby to gain a better understanding of the process and to discuss ways to implement a similar process within their teams.
Referrals Month Comphrensive Assessment No.direct allocation * +% OT PT MO Joint Total Total Referrals
May 182 0=0% 53 16 16 8 275
Jun 167 25=15% 54 23 21 10 275
Jul 193 107=55% 52 29 16 4 294
Aug 153 83=54% 39** 21 32 2 247
Sep 161 74=46% 39** 20 28 0*** 249
