Implementing a priority and waiting list system in an acute hospital setting

Abstract

This article outlines the development and review of the implementation of a process of prioritization and allocation of referrals to the occupational therapy team covering the medical wards in a 550-bed acute hospital in Swindon, UK. Before the implementation of the system, occupational therapists were ward aligned. Owing to the differing referral rates between wards, therapists experienced unequal caseloads. This created an inequitable service for patients, as some had to wait longer than others for assessment. Because of the limited evidence base available, the system was developed based on practice rather than evidence. Local social services guidelines were adapted to establish levels of priority of referrals. Standards for length of wait for assessment were devised using existing criteria from the rapid assessment service, the previous system under which the occupational therapy service tried to see patients due for imminent discharge. Under the new system, referrals were prioritized daily and placed in a central folder. All occupational therapists on the medical wards assessed patients in order of priority, regardless of ward. At the time of the audit, 2–3 occupational therapists were responsible for the discharge planning role across the five medical wards and patients were transferred to another setting for rehabilitation if required. The audit showed a high percentage adherence to the standards. Implementation of the system resulted in an equitable service for patients and more manageable, balanced caseloads for therapists.