Objective
In Ireland there are difficulties accessing public outpatient services across all specialties. With a population of just under 5 million, it is estimated that there were 550,000 patients on waiting lists for first hospital outpatient visits at the end of 2019. Fertility services are particularly poorly resourced.
Fertility is very time sensitive, with the biggest prognosticator in terms of the success of assisted reproduction treatment being female age. Long wait times are therefore detrimental for these patients and international comparisons show that Irish patients are older when they access fertility treatment.
We noticed that there was a very poor attendance rate at our public infertility clinics, possibly exacerbated by the long wait time for an appointment. The aim of this study was to implement a new appointment strategy to address these unacceptably long waiting times and to reduce the “did not attend” (DNA) rate.
Ultimately reducing the number of clinic appointments per patient and reduced waiting time to treatment and pregnancy.
Design
Retrospective comparative study
Materials and Methods
Prior to 2019, referral letters from family doctors were triaged by hospital nursing staff. Patients were sent an appointment slot and asked to complete specific fertility investigations (hormone profile and semen analysis) at the hospital prior to their scheduled appointment.
From March 2019, all patients were asked to complete and return a lifestyle and medical history questionnaire and to have the required tests performed at the hospital. Only then was an outpatient appointment slot was scheduled.
The outcome of all referrals received between March and August 2019 (new system) was compared with that of patients referred between March and August 2018 (old system).
Results
A total of 185 patient files were reviewed – n 78 (2018); 107 (2019)
Post implementation of the new system, the DNA (did not attend) rate was reduced from 32% to just 2%. Less than half of those initially referred (39%) returned the questionnaire and completed the required investigations therefore receiving an appointment.
For those who were given an appointment in 2019, the waiting time averaged 52 days compared to 178 previously. The total number of clinic visits needed to complete the basic work up reduced from two to one.
Disappointingly, it took, on average, 189 days to complete the basic investigations. However this is compared to almost a year (326 days) in 2018. The rate limiting factor contributing to this was the waiting time for a pelvic ultrasound, with the average wait being 120 days after initial consultation.
Almost one third of the women attending our clinic fell into the 35 – 39 age group category. Such a wait is not acceptable at this age.
Conclusions
By ensuring patients complete their basic investigations before they receive an appointment, we have drastically reduced waiting times and the DNA rate.
Now more than ever in this post COVID-19 era, we should aim to be streamlined and cost effective, prioritising our patients access to outpatient care. This approach could be adopted by other clinical services in Ireland to reduce clinic waiting times.
P-02 4:30 PM Saturday, October 17, 2020