106: From Fax Machine to First Appointment: Mapping The Management of Referrals to Pediatric Sub-Specialists
Notice bibliographique
Résumé
Wait time reduction for outpatient appointments has been connected to reduced healthcare costs and improved patient outcomes. At the pediatric hospital where this study was performed, one key goal of the administration was to reduce wait times for pediatric sub-specialists, particularly appointments for new referrals (also known as “Wait One”). However, attempts to measure and improve these entry-level wait times were hampered by an incomplete understanding of how referrals were handled by the sub-specialist divisions. The purpose of this ethnographic study was to describe the steps by which a new referral to each of ten of the pediatric sub-specialist divisions was processed, triaged, and booked. A qualitative study using standardized open-ended interview questions was carried out with each divisional administrator involved in referrals. They were asked to describe the process they followed from ‘when the new referral hits the fax machine’ to when the machine outpatient appointment was booked. Sub-specialist physicians in charge of triaging the referrals were also interviewed to gain greater insight into the process. In addition, employees in the central booking department, which most of the sub-specialist divisions use, were interviewed. Rough time estimates for the different steps were requested, if available. The data collected were arranged into flowcharts. The managements of referrals to sub-specialists had some similarities: all 10 had successful mechanisms for funneling urgent appointments into timely appointments if necessary. However, there was variation between divisions for less urgent new referrals: 60% of divisions utilized many triage categories based on three or more priority levels, and 20% booked based on ‘see by’ time frames, in contrast to others using only urgent and non-urgent categories; 30% had new referral declination/redirection measures to reduce backlog, while others accepted virtually all referrals; 30% pooled all referrals to be distributed to any specialist in the division, while others assigned a referral to a specific physician based on the preliminary diagnosis. These flowcharts we created highlight differences and similarities between divisions for dealing with new referrals. This information is useful in guiding future data collection on Wait One times in our hospital, and this in turn will help in the design and institution of effective and feasible measures for reducing such Wait One times.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,002 | 0,012 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,002 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,002 | 0,002 |
| Science ouverte | 0,001 | 0,002 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,003 | 0,001 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».