P291 Improvements in access to IBD care following the implementation of a novel tiered triage model
Notice bibliographique
Résumé
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. 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. 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). 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.
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 | 0,008 | 0,031 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,001 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,003 | 0,002 |
| Science ouverte | 0,001 | 0,003 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,013 | 0,003 |
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 ».