title: The British Columbia Nephrologists' Access Study (BCNAS) - a prospective, health services interventional study to develop waiting time benchmarks and reduce wait times for out-patient nephrology consultations.
abstract: BACKGROUND
  Early referral and management of high-risk chronic kidney disease may prevent or delay the need for dialysis. Automatic eGFR reporting has increased demand for out-patient nephrology consultations and in some cases, prolonged queues. In Canada, a national task force suggested the development of waiting time targets, which has not been done for nephrology.
  
  
  METHODS
  We sought to describe waiting time for outpatient nephrology consultations in British Columbia (BC). Data collection occurred in 2 phases: 1) Baseline Description (Jan 18-28, 2010) and 2) Post Waiting Time Benchmark-Introduction (Jan 16-27, 2012). Waiting time was defined as the interval from receipt of referral letters to assessment. Using a modified Delphi process, Nephrologists and Family Physicians (FP) developed waiting time targets for commonly referred conditions through meetings and surveys. Rules were developed to weigh-in nephrologists', FPs', and patients' perspectives in order to generate waiting time benchmarks. Targets consider comorbidities, eGFR, BP and albuminuria. Referred conditions were assigned a priority score between 1-4. BC nephrologists were encouraged to centrally triage referrals to see the first available nephrologist. Waiting time benchmarks were simultaneously introduced to guide patient scheduling. A post-intervention waiting time evaluation was then repeated.
  
  
  RESULTS
  In 2010 and 2012, 43/52 (83%) and 46/57 (81%) of BC nephrologists participated. Waiting time decreased from 98(IQR44,157) to 64(IQR21,120) days from 2010 to 2012 (p = <.001), despite no change in referral eGFR, demographics, nor number of office hrs/wk. Waiting time improved most for high priority patients.
  
  
  CONCLUSIONS
  An integrated, Provincial initiative to measure wait times, develop waiting benchmarks, and engage physicians in active waiting time management associated with improved access to nephrologists in BC. Improvements in waiting time was most marked for the highest priority patients, which suggests that benchmarks had an influence on triaging behavior. Further research is needed to determine whether this effect is sustainable.
authors.affiliation: British Columbia Provincial Renal Agency, 700, 1380 Burrard Street, Vancouver BC V6Z 2H3, Canada. mschac1@gmail.com.
authors.forename: Michael E
authors.initials: ME
authors.lastname: Schachter
authors.forename: Alexandra
authors.initials: A
authors.lastname: Romann
authors.forename: Ognjenka
authors.initials: O
authors.lastname: Djurdev
authors.forename: Adeera
authors.initials: A
authors.lastname: Levin
authors.forename: Monica
authors.initials: M
authors.lastname: Beaulieu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000458:organization & administration* / Q000592:standards; D019985:Benchmarking / Q000379:methods / Q000592:standards; D001955:British Columbia / Q000453:epidemiology; D017598:Efficiency, Organizational / Q000592:standards / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017146:Models, Organizational; D009398:Nephrology / Q000458:organization & administration* / Q000706:statistics & numerical data; D009937:Organizational Objectives; D011446:Prospective Studies; D012017:Referral and Consultation / Q000458:organization & administration* / Q000592:standards; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis* / Q000453:epidemiology; D014850:Waiting Lists