Issue link: https://maltatoday.uberflip.com/i/1181922
2 maltatoday | SUNDAY • 3 NOVEMBER 2019 NEWS MATTHEW VELLA MATER Dei Hospital says it is as yet un- able to farm out some of its specialties to health centres and other government institutions to reduce outpatients wait- ing lists, because no studies have yet been carried out on the proposal. The hospital had been advised by the National Audit Office to consider con- tracting outpatients services through public-private partnerships to decrease waiting times. But a cost-benefit analysis to see whether farming out and PPPs would be justified has not yet been carried out, an NAO follow-up has established. In 2017, Mater Dei was exploring which outsourcing of outpatient clin- ics would contribute to the reduction of patient waiting times. Outpatient clinics under consideration included Urology, Rheumatology, Respiratory, Diabetes and Gastroenterology. However, after various discussions between the main medical stakehold- ers and committee members, it was decided that such a proposal was not feasible and so was put on hold. This was mainly due to infrastructural limi- tations within the private sector and the unfeasible cost structure proposed. MDH had also considered the option to farm out some of its specialties to health centres or other government in- stitutions. "Up to the writing of this Report, MDH contends that farming out outpa- tient appointments may be a slow pro- cess as well as low in numbers. This is due to the need of setting discharge cri- teria as well as re-appointing criteria. "MDH [is] still discussing the estab- lishment of outpatient discharge and appointment criteria and how this could be validated in a farming out sce- nario. To date, MDH has not carried out or commissioned any studies in this regard." The original NAO audit had found that the average patient waits more than eight months for their first outpa- tient appointment at Mater Dei. The state hospital's 250-day waiting time average was double that in the UK and seven weeks longer than what Irish patients endure. Mater Dei receives roughly half a million outpatient visits every year, at an annual cost of approx- imately €32 million to taxpayers. That figure boils down to an average of €3.18 per minute for each consultation visit. Anything between 20 and 50 per cent of the annual 500,000 outpatient visits, for instance, were considered unneces- sary by senior clinicians and could have been handled by regional healthcare centres. Had such inappropriate refer- rals been caught in time, waiting times in specialisations such as genetics and neurology could have been halved, the study found. The hospital has also yet to fully im- plement an electronic system publish- ing real-time information relating to the waiting times for different consult- ants. The system, which could be in place in 2020, would allow patients togeth- er with their referring practitioner to make more informed decisions regard- ing their care. Mater Dei is also in the process of identifying and establishing key per- formance indicators (KPIs) on wait- ing times intended to further motivate the clinicians to reduce patient waiting times at the Outpatient Department. The introduction of a text mes- saging reminder system has only reduced the non-attendance rate for outpatient appointments from 30% to 22%, a study published in the Medical Journal back in April shows. Despite the decrease in no-shows since the introduction of the SMS system in 2017, the non-attend- ance rate remains "disturbing and continues to negatively influence Mater Dei's logistical and opera- tional arrangements and increase waiting times". The authors of the study called for improvements to the way patients' mobile telephone numbers are added to the hospital's electronic database, saying that 39% of pa- tients who did not attend appoint- ments insisted they never received the text reminder. It is estimated that the average cost to provide a consultation visit as an outpatient is around €3.18 per minute, depending on the spe- ciality. They are also suggesting that when patients call to reschedule their appointments, the cancelled appointment should be re-allo- cated to improve efficiency of the clinic. The study was based on attend- ance rates at four surgical out- patients' clinics where the total number of appointments were doc- umented over a period of a month. Non-attenders were contacted via a telephone call and asked to ex- plain their non-attendance as well as being asked if they had received a text-message reminding them of their appointment. Out of a total of 227 appointments (205 females, 22 males), 49 pa- tients did not turn up, representing a 22% non-attendance rate. Out of these 49 patients, 41 an- swered their phone and were inter- viewed for this study. The rest were not reached because a contact number was not in their physical and electronic records (2 patients) or they did not answer their phone at all (6 patients). Out of the 41 contacted, 16 (39%) claimed they did not receive a text message reminding them about their appointment, whilst acknowl- edging that they all have a func- tional mobile phone and they know how to receive and read a text mes- sage. While recognising the possibil- ity that some of these patients may have forgotten or were reluctant to own up, the authors insist that this should "raise an alert" that the hospital needs to keep mobile tel- ephone numbers updated on the electronic records system. "Wards and outpatient clerks should be reminded to update these records after every patient visit. It might al- so be possible to share a database with telephone service providers if this does not contravene data pro- tection legislation." Significantly only 39% of all the non-attendees contacted the sur- gical outpatients department be- forehand and postponed their ap- pointment to another date. 22% (9 patients) did not know at all about the appointment and 12% (5 pa- tients) forgot completely about the appointment. Seven patients knew about their appointment but they could not make it and did not inform anyone. Despite text reminders, 22% don't turn up for hospital appointments MDH contends that farming out outpatient appointments may be a slow process as well as low in numbers. This is due to the need of setting discharge criteria as well as re- appointing criteria No study yet on farming out outpatients specialties to cut waiting times