Characteristics of included studies
| Reference (year) and country | Study design | Sample size | Health system and specialty setting | Characteristics of SEM | Implementation process and fidelity |
|---|---|---|---|---|---|
| Leach et al. (2004), (12) England | Simple pre–post with non-equivalent group, time series | NA | Single payer, surgery: spinal | Pooled list, optional | A managed generic waiting list was implemented for initial outpatient appointment and subsequent surgery, and a computerized MRI booking system was integrated with outpatient follow-up appointments. As part of the managed generic waiting list, a consultant screened all new outpatient GP spinal referrals to assess suitability for a pooled waiting list, and patients were referred to next available physician. Same process was applied for managed generic waiting list for surgery. Implementation fidelity: NA |
| Bichel et al. (2009), (14) Canada | Simple pre–post with no equivalent groups, time series | 8289 patients | Single payer, internal medicine | Central access and triage, mandatory | The conference model preceded and allowed for development and implementation of the central access and triage system. The latter involved pooling referrals by specialty, using standardized information requirements and policy for confirmation of receipt of referral, as well as for acceptance of appointment. Wait times were measured in weeks to appointment, based on triage priority. Implementation fidelity: NA |
| Bungard et al. (2009), (15) Canada | Simple pre–post with non-equivalent groups, time series | 3096 patients | Single payer, cardiology | Single point of entry, optional | Cardiac EASE (January 2004–December 2006) was the single-point-of-entry model. Referrals were tracked through the MedTech database. All referrals were sent via fax to a single EASE intake service location and reviewed by EASE NP. Patients and referring FP were offered the choice of enrolling in EASE. Cardiologist involvement was voluntary, and most chose to participate. There was no advertising of the program. There was prompt feedback to the referring physician. Implementation fidelity: NA |
| Macleod et al. (2009), (10) Canada | Simple pre–post with non-equivalent groups, time series | NA | Single payer, surgery: hip and knee | Central intake, optional | The HKRP was a centralized intake model in which referrals were registered and triaged by an advanced practice physiotherapist. Six hospitals within the TC LHIN implemented the HKRP. There was a single wait list, with technology to support referral management. Implementation fidelity: TC LHIN was accountable for the HKRP. The organization monitored wait lists under the Wait Times Strategy and worked collaboratively with hospitals to improve TC LHIN wait list management processes. |
| Van den Heuvel et al. (2012), (16) Canada | Cross-sectional | 94 patients | Single payer, surgery: hernia clinic | Common waiting list, optional | Patients were put on a common waiting list to await next available physician. Clinic was run by 4 surgeons, as well as fellows, residents and students. All administrative data were input into a single database. Triage was performed by surgeon. Implementation fidelity: Letter was sent to FPs informing them of the new initiative. Patients received letter with date and time of appointment, along with information about the hernia clinic, health questionnaire and QoL questionnaire. |
| Schachter et al. (2013), (17) Canada | Prospective, pre–post with non-equivalent groups, time series | 920 patients | Single payer, nephrology | Central triage, optional | A physician-led provincial change strategy was implemented. Wait time issue was brought up in a preliminary survey at a BC nephrology conference in 2009. In addition, through a modified Delphi process, in-person meetings and surveys, wait time targets were established. Time targets took into account comorbidities, eGFR, BP and albuminuria. A priority score from 1 to 4 was assigned for referred conditions. Finally, the benchmark targets were approved by BC nephrologists at the BCPRA Medical Advisory Committee meeting and were then disseminated to all nephrologists in BC. A hard-copy reference sheet was provided for use during triage of new patients. Implementation fidelity: NA |
| Clark (2015), (11) Canada | Simple pre–post with non-equivalent groups, time series | NA | Single payer, chronic pain | Central intake, optional | All referrals were triaged by a nurse and administrative staff. Wait lists at 3 different sites were centralized, duplicates were identified, and a single wait list was formed. Implementation fidelity: NA |
| Hazlewood et al. (2016), (6) Canada | Simple pre–post with nonequivalent groups, time series | 8414 referrals | Single payer, rheumatology | Central intake, optional | CReATe Rheum was a centralized referral system. Referrals were sent via a single fax number. A standardized referral form was given to the RP, but the form was not enforced if all required information was given in the referral letter. A nurse with > 15 yr experience and 2 clerical support persons processed referrals to physicians. Any concerns with referrals were directed to 2 senior rheumatologists. A multiuser database was developed to track referrals, and missing information was obtained by sending a standardized form to the RP. Evaluation was conducted to determine impact over the short term (2 yr) and the long term (until 2013). Implementation fidelity: The 2 senior rheumatologists were involved in providing training to other rheumatologists to ensure easy transition to new system. |
| Wittmeier et al. (2016), (18) Canada | Simple pre–post with nonequivalent groups, time series | 1399 patients | Single payer, physiotherapy | Central intake, mandatory | A central intake system was implemented by the Child Health Physiotherapy team at the Health Sciences Centre in Winnipeg for children with complex needs. Implementation fidelity: NA |
| Goodsall et al. (2017), (19) Australia | Simple pre–post with nonequivalent groups, time series | 1118 referrals | Two-tier, gastroenterology | Single point of entry, mandatory | A pooled waiting list and centralized intake and triage with a “week on” roster for staff specialists was implemented. Intake and triage were categorized as “urgent” or “routine.” Patients were seen by the next available provider, and a rapid access clinic was established for urgent cases. Implementation fidelity: NA |
Note: BCPRA = BC Provincial Renal Agency, BP = blood pressure, CReATe Rheum = Central Referral and Triage in Rheumatology, EASE = Ensuring Access and Speedy Evaluation, eGFR = estimated glomerular filtration rate, FP = family physician, GP = general practitioner, HKRP = Hip and Knee Replacement Program, MRI = magnetic resonance imaging, NA = not available, NP = nurse practitioner, QoL = quality of life, RP = referring physician, SEM = single-entry model, TC LHIN = Toronto Central Local Health Integration Network.