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P291 Improvements in access to IBD care following the implementation of a novel tiered triage model

L. Wilson*1, D. Loomes1,2

1Vancouver Island IBD Clinic, Victoria, Canada, 2University of British Columbia, Faculty of Medicine, Vancouver, Canada

Background

Inflammatory bowel disease (IBD) requires early disease identification and close monitoring of disease activity. Centralised referral systems offer benefits in reduced wait times and opportunities for refinements in referral management. The Vancouver Island IBD Clinic obtains referrals through the regional gastroenterology (GI) group which receives an average of 750 referrals per month. In 2018, our intake system, GI Central Access and Triage (GICAT), was migrated onto a new platform within our electronic medical record allowing us to optimise referral management system-wide. As part of innovative changes to GICAT, we initiated distribution of all IBD referrals directly to IBD specialists for immediate triage. Along with review and prioritisation, immediate specialist triage facilitates proactive ordering of subsequent tests such as faecal calprotectin in a ‘tiered’ triage model to further refine referral management decisions. The aim of this study was to evaluate the short-term impact of our novel electronic tiered triage model on the processing of IBD referrals.

Methods

Referrals received by central fax were immediately distributed to GIs for triage, requiring identification of referral indication, pathway, urgency, and outstanding information or lab testing. Referrals were then expedited or returned to a common pool for distribution, with triages displayed on a real-time dashboard. Outstanding information was requested either prior to triage completion or scheduling. To understand enhancements to referral refinement, timing of referrals received and cancelled was measured over 10 months following implementation, as were changes to urgency and requests for information or testing. The number of weeks to initial consult for urgent IBD referrals and from referral date to GI triage were compared 6 months pre and post-implementation.

Results

In the first 10 months following the transition to GICAT, 7940 referrals were received with 18% per cent immediately cancelled or redirected via GICAT. Immediate triage facilitated requests for information and testing prior to consult in 29% of cases and changes to urgency in 62%. Time-to-triage was on average 22 weeks shorter for IBD referrals (24.3 vs. 2.2 weeks; p < 0.001) post-implementation. Wait times for urgent IBD consults were 2.4 weeks shorter in the post implementation audit (3.9 vs. 6.3; p = 0.044).

Conclusion

The transition to a novel triage management system decreased both time-to-triage and urgent wait times for IBD referrals. This process also expedited proactive testing, changes to urgency, and cancellation of inappropriate referrals. Centralised electronic tiered referral systems show great potential as innovative platforms for the rapid adaptive triage of IBD referrals in high volume centres.