Reducing wait times for hospital-based outpatient mental healthcare: what works?

Our hospital is an urban academic multisite facility in Southwestern Ontario. The General Adult Ambulatory Mental Health Service (GAAMHS) delivers acute urgent and non-urgent outpatient (O-P) psychiatric care for adults 18 to 64 years. In the context of sub-optimal physician resources and the COVID-19 pandemic, there was an accumulation of 812 non-urgent referrals in March 2021. Manual review of the number of incoming referrals and processing timelines estimated a wait time of 9 to 12 months to see a psychiatrist. This quality improvement project was conducted to resolve the backlog of referrals and to reduce the wait times for the incoming non-urgent referrals.

This project was developed and implemented by the core team of a programme manager, an administrative assistant (AA) and a psychiatrist. It was achieved without any additional funding for project management. Process mapping of various components of GAAMHS was completed and an Ishikawa diagram was created to identify factors contributing to the backlog. Quality improvement change ideas were proposed and tested using Plan-Do-Study-Act cycles. The interventions included reassessment of patient needs, implementation of an electronic data capture tool and team-based model of care, refining the referral triage process and standardising the service delivery practices of psychiatrists.

The 812 backlogged referrals were resolved in a median of 5.3 months. The average number of new consultations and total O-P visits per full-time psychiatrist per month was 10.3 ±3.6 and 74.5±15.9, respectively, in 2020; it increased to 17.1±7.9 and 80.8±21.6 in 2022 and 18.8±8.9 and 90.0±20.2 in 2023. The wait times for the new incoming referrals have continued to decrease with the median wait times in December 2023 being 102 days and the wait times for the 75th percentile being 145 days.

A combination of strategies helped resolve the backlog and reduce wait times to access acute O-P mental health.