A Network analysis of more than 3100 referrals to hospital-based outpatient rehab provides a clearer picture of patients who are declined. The data also begin to address a long-standing data gap that has made system-wide capacity planning difficult.
The Network worked with seven Toronto hospitals to track all outpatient rehab referrals received from October to December 2017. The referrals were then monitored until March 2018 to determine whether they were accepted or declined, the reason for being declined and how long the patients had to wait for services.
An analysis of the data provided the following insights:
- Who was accepted: 90% of referrals were accepted.
- Who was declined: 9% of referrals were declined. The patient groups with the highest proportion of declined referrals were geriatric/medicine (18%), ortho conditions (16%), neuro (13%) and arthritis/pain (28%). QPB patients groups (total hip & knee, hip fracture and stroke) had lower declined referral rates, ranging from 1% to 6%.
- Why they were declined: The top reasons referrals were declined include the following:
- program didn’t offer the requested services
- program doesn’t accept single-service referrals
- patient was outside the program’s catchment area
- too much time had passed since the date of onset/injury
- program’s wait time can’t meet the best practice timeframe
- Who had to wait: Wait times were longest for services for a specific medical conditions (e.g., neurological and cardiac conditions, geriatric patient groups) or services that provide specialty services (e.g., pain management, seating clinics). Patients referred for a consultation/assessment or for education/self-management waited approximately 50 days — twice as long as other patients.
The full analysis of the data was provided to participating organizations and the Toronto Central LHIN to assist in their capacity planning for community-based rehabilitative care. As local discussions on creating Ontario Health Teams progress, this information can also be used to assist teams in their planning.
For more information, please contact project manager Sharon Ocampo-Chan.