Hospitals are facing growing demand for specialist appointments, alongside the challenge of ‘finite’ resources and capacity. 

As a result, healthcare providers are increasingly looking to alternative models of care to take the pressure off outpatient departments.

So, let’s take a look at some of the current (and emerging) alternative models of care, the benefits of different patient pathways, and how to integrate alternative care models with your existing hospital and outpatient processes.

What’s an Alternative Model of Care?

Alternative models of care involve diagnosing, treating, and managing patients (that would typically be seen in an outpatient department) under an alternative care provider or in another location. 

This may involve a mix of hospital-based and community-based care providers throughout the patient journey. Or in some cases, patients may be redirected to another care provider to manage their care from the point of referral.

Why Use Alternative Models of Care?

Alternative models of care can have a number of benefits, including:

• Reduced demands on hospital outpatient departments and resources – They can reduce pressure on busy outpatient clinics because a portion of referred patients may not need to come into hospital at all, or may be able to be discharged sooner.
• More patients can be seen sooner – Directing patients to alternate pathways is usually a strategy that stems from having capacity in another area. But if there is capacity, it typically means shorter wait times.
• Better clinical outcomes – Reduced wait times for diagnosis and treatment typically means better clinical outcomes for patients.
• Better focused hospital resources – Hospital clinicians can focus on more urgent cases or patients that require specialised treatments.
• Improved access to care – Some models may make it easier for patients to receive care in their local areas rather than having to access tertiary facilities typically based in large cities.
• More options – Having access to clinicians that have different clinical backgrounds often means more care options and therefore greater patient choice.
• Better value – Many alternative models offer a more affordable way to diagnose, treat, and manage patients, compared to resource-heavy hospital clinics.
   

Alternative Models of Care to Explore

Here are some of the most common alternative models of care that are being used in healthcare today.

GP Shared Care

A shared care arrangement with a GP may involve training GPs to better diagnose, monitor, and treat health conditions with the support of specialists. GP shared care keeps people out of hospitals as much as possible and avoids unnecessary travel. 

This model is especially practical for patients in remote areas that might need regular testing and monitoring. For example:

GP Shared Care With Maternity Services
Women who have low risk pregnancies attend their GP throughout their pregnancy for routine check ups, referrals for ultrasound, and birth planning. This enables women to be supported by a familiar care provider, receive care close to home, and have greater flexibility with their appointments. For hospitals, this frees up obstetrician time for women with higher risk pregnancies.

GP With Special Interest ENT Clinics
Recent research has shown children who experience learning difficulties at school can be a result of lack of sleep and difficulty hearing. As a result, demand for ENT appointments has increased significantly.  But not all children require surgical intervention. With GP shared care, GPs work alongside ENT doctors and are trained to assess children with recurrent tonsillitis and/or ear conditions to understand suitability for surgery, and/or provide conservative treatment options while they wait.

GP Procedure Clinics
In this situation, a GP works within a dermatology or plastic surgery clinic, allowing them to assess and perform minor procedures on skin conditions. In jurisdictions where there is excessive demand for dermatologists, this is an attractive model of care.
 

Allied Health Services

If a referral or initial appointment reveals that a patient is more suitable for non-surgical treatment, they are often a good candidate for a referral to allied health services. Some common types of allied health providers include:

• Dietitians for patients who are experiencing ‘functional gut’ conditions (as an alternative to Gastroenterology)
• Occupational therapists for upper limb care (as an alternative to Orthopaedic Surgery
• Physiotherapists for musculoskeletal and back pain conditions (as an alternative to Orthopaedic, Spinal, or Neurosurgery)
• Podiatrists for foot and ankle conditions (as an alternative to Orthopaedic Surgery)
• Psychologists for the management of pain, support for mental health conditions, and acceptance of chronic disease
• Social workers
• Speech pathologists for non-surgical mouth conditions (as an alternative to ENT or even maxillofacial surgery)
• Audiologists for non-surgical ear conditions (as an alternative to ENT)
• Optometrists for the management of non-surgical eye conditions (as an alternative to Ophthalmology)

Allied health wait times tend to be shorter than specialist  clinic wait times, particularly for non-urgent cases.

 

Allied health wait times tend to be shorter than outpatient clinic wait times, particularly for non-urgent cases. One study of mental health patients showed that allied health professionals can significantly reduce waiting times, compared to waiting for a specialist outpatient appointment.

This strategy is very effective if there are sufficient resources available and protocols in place to support end to end care. Demand analysis should be undertaken prior to commencing the model to ensure enough capacity will be available to manage the demand and avoid creating longer queues for these services than the original pathway.

Nurse-Led Clinics

Usually, nurse-led clinics are clinics where the main care provider is a nurse who has access to a specialist consultant for supervision or escalation.

Some jurisdictions are already trialling specialist clinics for specific cohorts that may utilise nurse practitioners or specialised nurses for consultations, screening, education, and treatment. This can help to treat more patients sooner in specialties where demand exceeds capacity.

For example, QLD Health implemented several alternative models of care to tackle peak long waits in Neurology Outpatients, treating an additional 165 new patients from February – July 2017. This included nurse led screening for migraines, as well as seizure and multiple sclerosis (MS) clinics.  
 

The shift to specialist clinics is necessary to create capacity, but there will likely be some resistance to change from professional groups that traditionally owned certain skills.

 

As jurisdictions begin to use this health model more broadly, we’ll likely see more discussion around the scope of practice for each professional group. For example, some skills and procedures that were once only practised by doctors may shift to nurses or nurse practitioners as they become lower risk and more routine. This shift is necessary to create capacity in hospital departments, better utilise resources, and reduce patient wait times — but there will likely be some resistance to change from the professional groups that traditionally owned certain skills.

Telehealth

Telehealth appointments can be used for screening clinics, initial appointments, follow up or review clinics, and even post-discharge following an inpatient stay.

We saw a dramatic rise in telehealth appointments throughout the COVID-19 pandemic as healthcare providers and patients found ways to social distance and minimise contact. 

Many patients are returning to face-to-face appointments — and of course, many types of care are only possible through face-to-face. But online tools remain (along with greater acceptance of using them), making this an ideal time to further integrate telehealth into more health services.
 

Online tools such as telehealth, and the acceptance of them as a reasonable care option remains, making this an ideal time to further integrate telehealth into more health services.

 

Although it has some drawbacks and limitations, telehealth has a number of benefits, like:

• More efficient appointments, enabling more consultations per day
• Less crowded waiting rooms
• Fewer clinic rooms needed
• Reduced need for cancellation due to acute illness or lack of transport
• Less need for patient transport services and patient travel
• Easier access for patients in rural areas
• Easier access for patients with mobility issues

With the right technology and a new generation of doctors and patients emerging (who are increasingly comfortable with digitised health options), we will likely see telehealth become more normalised and standardised as part of the patient journey. 
 

Home Programs

Self-management through ‘home programs’ can be done at home. With the right education, devices, and support team on call, patients can monitor their own symptoms at home. If they notice a change in their condition, they can contact their GP or other care provider early on, rather than waiting for a specialist appointment. This can have a number of advantages:

• Patients are empowered to take charge of their care
• Patients can stay in their home environment for longer
• Reduced demand on hospital resources
• Patients may be able to get treated sooner, which may result in fewer surgical interventions
   

Get Your Stakeholders Onboard

Ready to explore more alternative models of care and integrate them into your outpatient clinic processes?

You’ll first need to work with both internal hospital stakeholders as well as external health service providers to explore partnerships and ways to integrate more alternate pathways. You’ll need to get aligned on goals like redirecting demand, increasing capacity, improving access, and providing better patient outcomes. 

Use hospital data on demand, waitlists dynamics and capacity, along with proven outcomes to help build support for alternative models of care.
 

Looking for hospital improvement software to support better waitlist management? SystemView integrates data from all your hospital source systems into a single, beautiful dashboard that delivers meaningful insights on your outpatient waitlists (along with hundreds of other metrics across all your departments). Learn more about what you can do inside SystemView >>

 

Adjust Your Outpatient Processes

Once your stakeholders are onboard, you’ll need to review (and possibly adjust) your referral, booking, and triage processes in outpatients to incorporate alternative care models.

You may need to audit your referrals and waitlists to ensure you have quality referrals that outline the referred condition (in enough detail). If you don’t have the details you need, you’ll have to follow up with referring GPs to request more information and provide guidance for referral quality in the future.
 

Audit your referrals and waitlists to ensure you the right level of detail to understand what condition your patient is being referred with.

 

With quality referrals, you can identify any non-urgent patients that are good candidates for treatment under another suitable model of care. Then you can redirect them to another provider. 

That said, it’s also worth mentioning that alternative models of care may also apply at future points in the patient journey. In some cases, a patient may benefit from an initial outpatient clinic appointment before deciding on the best model of care. 
 

Share Your Knowledge

There’s a huge trend towards alternative models of care — chances are, your counterpart in another hospital is currently exploring the same strategies as you. 

So, if you learn something interesting from your data analytics or the alternative care models you’re trialling, then share it with others. And if you’re facing a specific issue, reach out for help from the community. Someone else may already have the answer you’re looking for.

Want to contribute to our community? Check out our Outpatients User Group here.

How Are You Incorporating Alternative Models of Care?

What’s worked well for you so far when integrating alternative care models? What hasn’t? Or is there a topic related to this that you’d like us to cover in future pieces? Leave a comment below.

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