Reducing geriatric outpatient waiting times: Impact of an
advanced health practitioner
Robyn L Saxon
Queensland Health, Brisbane; University of the Sunshine Coast; and
Cluster for Health Improvement, University of the Sunshine Coast,
Sunshine Coast, Queensland, Australia
Marion A Gray and Florin I Oprescu
University of the Sunshine Coast; and Cluster for Health
Improvement, University of the Sunshine Coast, Sunshine Coast,
Objective: To investigate the impact on patient waiting
times of a role substitution model introducing an advanced
allied health practitioner as the ﬁrst point of contact within
a geriatric outpatient context.
Methods: A pre- to postintervention design was used to
determine impact over a ﬁve-year period (2008–2012). All
patients referred to the geriatric specialist outpatient
department were included (n = 1514). Data relating to
waiting times were analysed using one-way ANOVA and
post hoc Tukey tests to determine effects on patient
Results: Waiting times were reduced from an average of
82 to as low as 35 days, in a context of increasing referral
rates. Medical specialist capacity was increased through
improvements to available outpatient times and reduced
appointment lengths. Patients seen within their designated
triage category timeframe increased from 47 to 86%.
Conclusion: Health professional substitution in geriatrics
can be an effective intervention for reducing patient
waiting times and improving access to care.
Policy Impact: Allied health practitioner role
substitution models can improve patient ﬂow, access to
care and clinician time utilisation, in contexts such as
geriatric outpatient services.
Practice Impact: Role substitution using allied health
practitioners can reduce patient waiting times for care.
In a geriatric outpatient setting the waiting time was
reduced from an average of 82 to as low as 35 days.
The percentage of patients seen within their designated
triage category increased from 47 to 86%.
Key words: allied health personnel, health services for the
aged, health services needs and demand, waiting lists.
Health services have been reported as having ‘access-block’,
with patients experiencing increasingly long waiting times
[1–4]. This block has been attributed to a shortage of medi-
cal specialists [3,5–7]. A number of specialities have been
affected by current shortages and predicted shortages,
including orthopaedics and geriatrics [8–12]. Some of these
shortages relate to an ageing workforce, difﬁculty with the
way services are delivered, public versus private providers,
location of the specialists’ practice – particularly in rural and
remote regions of Australia, and an inability to attract trai-
Longer waiting lists have been proposed to equate to
poorer patient outcomes. Poorer outcomes may be due to
longer waiting times resulting in more time to diagnosis or
treatment, thus allowing progression of disease or an
avoidable event, such as hospital admission and emergency
department presentation [2,4,10,13,17,18].
In previous decades, efforts made by health services to
identify and respond to these deﬁcits have generally
focused on targeting incentives to increase medical special-
ist numbers and activity levels [8,10,19,20]. However,
there remains an issue of access-block to medical specialist
care. More recent solutions to address long waiting lists
have focused on role substitution, or task transference from
medical practitioners, and the development of new roles
such as the nurse practitioner, physician assistant and the
advanced allied health practitioner [1,21–23]. Successes
with utilising expanded allied health profession roles to
reduce patient waiting times to care and releasing medical
specialist time for more complex care have been increas-
ingly reported in the literature [5,6,18,21–23]. These new
roles typically involve non-medical health practitioners,
who have extensive experience in a particular patient popu-
lation or diagnostic group, receiving additional training to
perform tasks usually performed by medical practitioners.
With a larger proportion of the world’s population expected
to live longer and with more chronic disease, there is a pre-
dicted increased pressure on already stretched health-care ser-
vices. Frail older people are more susceptible to negative
impacts due to longer waiting times for care than generally
healthy populations [4,17,24]. The speciality area of geriatric
medicine has been identiﬁed as the logical leader in provision
of care for this vulnerable population [10,14]. However, geri-
atric medicine has a documented worldwide shortage, and
difﬁculty attracting trainees [8–10,12,14]. A shortage of
Correspondence to: Mrs Robyn L Saxon, Sunshine Coast Hospital
and Health Service, Nambour Hospital.
Australasian Journal on Ageing, Vol 37 No 1 March 2018, 48–53
2017 AJA Inc.