• Deborah A Marshall, Toni Tagimacruz, Claire E H Barber, Monica Cepoiu-Martin, Elena Lopatina, Jill Robert, Terri Lupton, Jatin Patel, and Diane P Mosher.
• McCaig Bone and Joint Health Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
• J Eval Clin Pract. 2024 Mar 1; 30 (2): 199208199-208.

RationaleTimely assessment of a chronic condition is critical to prevent long-term irreversible consequences. Patients with inflammatory arthritis (IA) symptoms require diagnosis by a rheumatologist and intervention initiation to minimize potential joint damage. With limited rheumatologist capacity, meeting urgency wait time benchmarks can be challenging. We investigate the impact of the maximum wait time guarantee (MWTG) policy and referral volume changes in a rheumatology central intake (CI) system on meeting this challenge.MethodsWe applied a system simulation approach to model a high-volume CI rheumatology clinic. Model parameters were based on the referral and triage data from the CI and clinic appointment data. We compare the wait time performance of the current distribution policy MWTG and when referral volumes change.ResultsThe MWTG policy ensures 100% of new patients see a rheumatologist within their urgency wait time benchmark. However, the average wait time for new patients increased by 51% (178-269 days). A 10% decrease in referrals resulted in a 76% decrease on average wait times (178-43 days) for new patients and an increase in the number of patients seen by a rheumatologist within 1 year of the initial visit.ConclusionAn MWTG policy can result in intended and unintended consequences-ensuring that all patients meet the wait time benchmarks but increasing wait times overall. Relatively small changes in referral volume significantly impact wait times. These relationships can assist clinic managers and policymakers decide on the best approach to manage referrals for better system performance.© 2023 John Wiley & Sons Ltd.

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