OBJECTIVES: Increasing demand as a result of a `freedom of choice´ policy poses additional challenges to Portuguese hospitals and may paradoxically limit access to speciality care. This study describes the results of a quality improvement project aiming to increase access to speciality care in a tertiary hospital in Portugal.

METHODS: The intervention started in October 2017 at Centro Hospitalar Sao João. Based on clinical information provided on referral from primary care, senior orthopaedics and rheumatology specialists identify a subset of patients on the waiting list likely to need fewer, ideally one, hospital appointments until a treatment plan can be safely transferred back to the responsibility of primary care. These patients are scheduled for a fifteen-minute speciality first appointment (compared to the usual 30 minutes). Pre- (March to September 2017) and post-intervention (October 2017 to May 2018) median waiting times (MWT - from referral until the first appointment) were compared, taking into account the variation of patients admitted to the waiting list.

RESULTS: Before the intervention, an average of 308 and 886 patients per month were referred for rheumatology and orthopaedics, respectively. In September 2017, the MWT was 156 days for rheumatology and 109 days for orthopaedics (having increased an average of 3 and 5 days per month since March, respectively). From October 2017 to May 2018, there was a 9% decrease in the number of monthly admissions in rheumatology and MWT decreased 38 days (average -5 days/month). In orthopaedics, admissions increased 1% and the MWT increase deaccelerated to 4 days (average 1 day/month).

CONCLUSIONS: The 6 months results suggest that this intervention may yield beneficial results in reducing wait times and integration between levels of care, without imposing significant costs. This creative strategy may be generalizable to other specialties with lengthy wait times, improving health care accessibility, efficiency and equity.