Waiting time information services: what are the implications of waiting list behaviour for their design?

2002 ◽  
Vol 25 (4) ◽  
pp. 40 ◽  
Author(s):  
David Cromwell ◽  
David Griffiths
Keyword(s):  
Waiting Time ◽  
Elective Surgery ◽  
Waiting Times ◽  
Waiting Lists ◽  
Information Services ◽  
Waiting List ◽  
Surgical Units ◽  
Time Information ◽  
Over Time ◽  
Sydney Australia

In some countries, patients requiring elective surgery can access comparative waiting time information for various surgical units. What someone can deduce from this information will depend upon how the statistics are derived, and how waiting lists behave. However, empirical analyses of waiting list behaviour are scarce. This study analysed three years of waiting list data collected at one hospital in Sydney, Australia. The results highlight various issues that raise questions about using particular waiting time statistics to make inferences about patient waiting times. In particular, the results highlight the considerable variation in behaviour that can exist between surgeons in the same specialty, and that can occur over time.

scholarly journals Waiting time information services: how well do different statistics forecast a patient's wait?

2002 ◽  
Vol 25 (6) ◽  
pp. 75 ◽  
Author(s):  
David A. Cromwell ◽  
David A. Griffths
Keyword(s):  
Waiting Time ◽  
Public Hospital ◽  
Elective Surgery ◽  
Waiting Times ◽  
Information Services ◽  
Waiting List ◽  
Web Based ◽  
Time Information ◽  
Sydney Australia ◽  
Patient Waiting

This study investigates how accurately the waiting times of patients about to join a waiting list are predicted by the types of statistics disseminated via web-based waiting time information services. Data were collected at a public hospital in Sydney, Australia, on elective surgery activity and waiting list behaviour from July 1995 to June 1998.The data covered 46 surgeons in 10 surgical specialties. The accuracy of the tested statistics varied greatly, being affected more by the characteristics and behaviour of a surgeon's waiting list than by how the statistics were derived. For those surgeons whose waiting times were often over six months, commonly used statistics can be very poor at forecasting patient waiting times.

HOW TO REPORT AND MONITOR THE PERFORMANCE OF WAITING LIST MANAGEMENT

2002 ◽  
Vol 18 (3) ◽  
pp. 611-618
Author(s):  
Markus Torkki ◽  
Miika Linna ◽  
Seppo Seitsalo ◽  
Pekka Paavolainen
Keyword(s):  
Hallux Valgus ◽  
Waiting Time ◽  
Varicose Vein ◽  
Elective Surgery ◽  
Waiting Times ◽  
Waiting List ◽  
Mean Waiting Time ◽  
Number Of Patients ◽  
Potential Problems ◽  
Queue Discipline

Objectives: Potential problems concerning waiting list management are often monitored using mean waiting times based on empirical samples. However, the appropriateness of mean waiting time as an indicator of access can be questioned if a waiting list is not managed well, e.g., if the queue discipline is violated. This study was performed to find out about the queue discipline in waiting lists for elective surgery to reveal potential discrepancies in waiting list management. Methods: There were 1,774 waiting list patients for hallux valgus or varicose vein surgery or sterilization. The waiting time distributions of patients receiving surgery and of patients still waiting for an operation are presented in column charts. The charts are compared with two model charts. One model chart presents a high queue discipline (first in—first out) and another a poor queue discipline (random) queue. Results: There were significant differences in waiting list management across hospitals and patient categories. Examples of a poor queue discipline were found in queues for hallux valgus and varicose vein operations. Conclusions: A routine waiting list reporting should be used to guarantee the quality of waiting list management and to pinpoint potential problems in access. It is important to monitor not only the number of patients in the waiting list but also the queue discipline and the balance between demand and supply of surgical services. The purpose for this type of reporting is to ensure that the priority setting made at health policy level also works in practise.

The Cardiac Waiting Game: Are Patients Prioritized on the Basis of Clinical Need?

1997 ◽  
Vol 10 (4) ◽  
pp. 216-224 ◽  
Author(s):  
S. Langham ◽  
M. Soljak ◽  
B. Keogh ◽  
M. Gill ◽  
M. Thorogood ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Waiting Time ◽  
Smoking Status ◽  
Current System ◽  
Artery Bypass ◽  
Waiting Times ◽  
Waiting Lists ◽  
Waiting List ◽  
Use Of Resources

Waiting lists for coronary artery bypass grafting (CABG) have been a recurring problem for many hospitals, putting pressure on hospitals to manage waiting lists more effectively. In this study, we audited the records of 1594 patients who had coronary artery bypass surgery in 1992 and 1993 in three London hospitals, to assess their waiting time experience. Patients' actual waiting times were compared with an appropriate waiting time defined using an adapted version of a Canadian urgency scoring system. Influence of other factors (sex, age, smoking, hypertension, diabetes and obesity) on actual waiting time was assessed. A comparison of patients' actual waiting times with an appropriate waiting time, defined by the urgency score, showed that only 38% were treated within the appropriate period. Thirty-four per cent were treated earlier than their ischaemic risk indicated, and 28% with high ischaemic risk were delayed. Actual waiting time was associated with a patient's sex and smoking status but not with the other factors studied. The current system of prioritizing patients awaiting CABG is not concordant with a measure of appropriate waiting time. This could have arisen due to a number of factors, including the contracting process, waiting list initiatives, and methods of waiting list administration and patient pressures. The use of a standard method for prioritizing patients would enable a more appropriate use of resources.

scholarly journals Increasing efficiency for reducing elective surgery waiting times: a multi-interventions approach

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
C Quercioli ◽  
G A Carta ◽  
G Cevenini ◽  
G Messina ◽  
N Nante ◽  
...  
Keyword(s):  
Waiting Time ◽  
General Surgery ◽  
Time Allocation ◽  
Optimal Allocation ◽  
Elective Surgery ◽  
Waiting Times ◽  
Operating Time ◽  
District General Hospital ◽  
Waiting List ◽  
Mean Waiting Time

Abstract Background Elective surgery long waiting times are a common problem in publicly funded health systems. They have been tackled allocating additional resources or using existing resources more efficiently but results are patchy. We studied the effectiveness of a multi-interventions project based on the reorganization of existing capacity. Methods In a district general hospital (Siena's Province, Italy) with 150 beds, 4 elective surgery operating rooms (ORs) opened 6 hours/day 5 days/week (surgery specialties: general surgery, orthopedics, gynecology and urology) in October 2018 a project for reducing surgery waiting times was implemented based on 3 key points: i) separation of the Day Surgery (DS) flow from that of the ordinary activity; ii) increase of available operating time through reorganization of personnel: 30 additional hours/week were made available; iii) allocation of operating sessions flexibly in proportion to the waiting list: the made-available hours were redistributed through an algorithm able to estimate the optimal allocation of surgical time blocks to minimize the length of waiting lists, taking account of the interventions priority class. The waiting time of the out from 1/10/2019 to 31/12/2019 (N = 635) was compared with that of the interventions carried out from 1/10/2018 to 31/12/2018 (N = 634) using t-test. Results Waiting times for non-urgent cases (that can be operated beyond 30 days) were significantly reduced for all specialties (p < 0.01) except urology. For general surgery, orthopedics and gynecology, DS interventions' mean waiting time decreases from 198 to 100 days (-50%) that one of ordinary interventions from 213 to 134 days (-37%). Waiting time for urgent cases (to be operated within 30 days) was also reduced. Conclusions A multi-interventions project based on using existing capacity (personnel and structures) more efficiently and improving planning methodologies resulted to be strongly effective in reducing waiting times for elective surgery. Key messages To effectively reduce surgical waiting times, a strategy is needed that involve the entire process: from surgical planning, to staff and structures organization. The flexible OR time allocation on the base of the waiting list is a key point to improve surgery planning and reduce waiting list.

scholarly journals Erratum for Cromwell DA, Griffiths DA 2002

2003 ◽  
Vol 26 (1) ◽  
pp. 219
Author(s):  
DA Cromwell ◽  
DA Griffiths
Keyword(s):  
Waiting Time ◽  
Information Services ◽  
Time Information

Erratum for Cromwell DA, Griffiths DA 2002, 'Waiting time information services: how well do different statistics forecast a patient's wait?'

scholarly journals High emergency organ allocation rule in lung transplantation: a simulation study

2017 ◽  
Vol 3 (4) ◽  
pp. 00020-2017 ◽  
Author(s):  
Julien Riou ◽  
Pierre-Yves Boëlle ◽  
Jason D. Christie ◽  
Gabriel Thabut
Keyword(s):  
Lung Transplantation ◽  
Waiting Time ◽  
Waiting Times ◽  
Organ Allocation ◽  
Waiting List ◽  
Allocation Rule ◽  
Long Term Effects ◽  
Term Survival ◽  
The Impact

The scarcity of suitable organ donors leads to protracted waiting times and mortality in patients awaiting lung transplantation. This study aims to assess the short- and long-term effects of a high emergency organ allocation policy on the outcome of lung transplantation.We developed a simulation model of lung transplantation waiting queues under two allocation strategies, based either on waiting time only or on additional criteria to prioritise the sickest patients. The model was informed by data from the United Network for Organ Sharing. We compared the impact of these strategies on waiting time, waiting list mortality and overall survival in various situations of organ scarcity.The impact of a high emergency allocation strategy depends largely on the organ supply. When organ supply is sufficient (>95 organs per 100 patients), it may prevent a small number of early deaths (1 year survival: 93.7% against 92.4% for waiting time only) without significant impact on waiting times or long-term survival. When the organ/recipient ratio is lower, the benefits in early mortality are larger but are counterbalanced by a dramatic increase of the size of the waiting list. Consequently, we observed a progressive increase of mortality on the waiting list (although still lower than with waiting time only), a deterioration of patients’ condition at transplant and a decrease of post-transplant survival times.High emergency organ allocation is an effective strategy to reduce mortality on the waiting list, but causes a disruption of the list equilibrium that may have detrimental long-term effects in situations of significant organ scarcity.

scholarly journals P-EGS14 From Gallstone Disease to Cholecystectomy: An audit looking at the waiting times for cholecystectomy in a small District General Hospital

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
Jacob Mewse ◽  
Virginia Ledda ◽  
Ellie Connor ◽  
Peter Frank Mason
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Waiting Time ◽  
Negative Impact ◽  
Elective Surgery ◽  
Waiting Times ◽  
Gallstone Disease ◽  
Gastrointestinal Surgery ◽  
Emergency Operation ◽  
Biliary Colic ◽  
Emergency General Surgery

Abstract Background Gallstone-related disease accounts for a third of emergency general surgery admissions and referrals. The average waiting time for acute gallstone presentations to laparoscopic cholecystectomy is about 7 days in England. This audit aims to identify emergency admissions and compare local management to the Association of Upper Gastrointestinal Surgery of Great Britain and Ireland (AUGIS) guidelines standards with a focus on waiting times for laparoscopic cholecystectomy (LC). Where AUGIS standards were not met, number of re-admissions and complications were identified. A cost analysis was also completed looking at the overall costs of delayed treatment. Methods We identified all patients admitted as an emergency between September 2019 and September 2020 with gallstone-related pathology. Patients not referred to the surgical team, with negative Ultrasound Scans (USS) or known HPB malignancy were excluded. The patients were divided into a pre- COVID -19 and during COVID-19 category (respectively before and after March 2020), to identify whether the cancellation to non- urgent elective surgery (due to COVID-19) had caused further delays or complications. Each patient’s management was compared to AUGIS guidelines depending on their diagnosis at presentation (biliary colic, cholecystitis, cholangitis, gallstone-related pancreatitis), focusing on the timing between presentation and LC. Results A total of 99 patients were identified. Of the patients presenting with biliary colic (n = 9 pre-COVID, n = 5 during COVID), none underwent LC within 72 hours from presentation as recommended by AUGIS. Of the patients presenting with cholecystitis (n = 20 pre-COVID and n = 16 during COVID), none had LC within the recommended 72 hours. 5 patients in each COVID group had LC, with a significantly longer waiting time compared to the pre-COVID group. Re-admissions and complications were similar for the cholecystitis patients in both COVID groups. In the gallstone-related pancreatitis group, only 1 patient underwent LC within the recommended 2 weeks. Conclusions This audit showed that locally we are failing to meet AUGIS guidelines for LC within 72 hrs, 2 weeks or 6 weeks both pre and during COVID. This has caused re-admissions of patients with cholecystitis, pancreatitis and perforated gallbladders. Factors that cause delay are limited access to USS, limited staff and theatre availability. To improve outcomes, it is necessary to implement a hot gallbladder service with dedicated theatre slots. A change in the overall perception of LC is also needed: this is should be considered an emergency operation as its delay has a significant negative impact on patients’ outcomes.

scholarly journals P-BN44 The impact of the COVID-19 pandemic on waiting lists for laparoscopic cholecystectomy and its effect on patient care and outcomes

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
Geraint Herbert ◽  
Charlotte Thomas
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Patient Care ◽  
Positive Impact ◽  
Elective Surgery ◽  
Emergency Operation ◽  
Waiting Lists ◽  
Waiting List ◽  
Subtotal Cholecystectomy ◽  
Significant Difference ◽  
The Impact

Abstract Background It has been widely reported that the COVID-19 pandemic has had a detrimental impact on waiting lists for elective surgery in the NHS. Delays in laparoscopic cholecystectomy (LC) are likely to prolong suffering for symptomatic patients and risk increasing complications for patients which may then require emergency care and intervention. In this study we aim to quantify the impact of the COVID-19 pandemic on elective waiting lists and to assess what implications this might have on patient care and outcomes.  Methods Electronic health records were retrospectively interrogated for patients undergoing LC in both March 2019 (prior to the COVID-19 pandemic) and March 2021. The following data was captured: age, gender, elective vs emergency operation, laparoscopic vs open, total vs subtotal cholecystectomy, use of drains, length of stay/daycase rates, the number of emergency presentations prior to operation and the number of days between being listed for surgery and their operation. The results were analysed using SPSS Statistics (IBM, New York).  Results 111 patients were included in the study (25 male and 86 female). Of these, 60 had their LC in 2019, and 51 in 2021. The age and gender distribution of the patients in both time periods were similar. The median number of days on the waiting list was significantly higher (P < 0.001) for patients in 2021 at 379.5 days, compared with 153 days in 2019. There was a significant increase in the number of emergency presentations prior to LC in 2021 (P = 0.025) with an average of 0.7 presentations per patient compared with 0.45 in 2019. Additionally, there was a significant increase in the number of emergency LC performed in 2021 (P = 0.002), with 15 performed compared with 4 in 2019, representing 29.4% and 6.7% of all LC respectively. There was no significant change in rates of conversion to open, drains or subtotal cholecystectomy. There was no significant difference in daycase rates for elective patients in either period (55% vs 58%). Conclusions Whilst there has been no change in the operative outcomes for patients undergoing LC, there has been a stark increase in the length of time patients are on a waiting list prior to undergoing elective LC. This has resulted in a significant increase in the number of emergency presentations and the number of emergency LC performed. This study demonstrates the wider impact of increasing waiting list times beyond the prolonged suffering of symptomatic patients. A significant reduction in waiting list times would be beneficial to both patients and healthcare providers, with the aim of reducing the number of emergency presentations. A reduction in these would have a positive impact on acute services and on the associated cost implications.  

scholarly journals A new model to prioritize waiting lists for elective surgery under the COVID-19 pandemic pressure

2020 ◽  
Author(s):  
Roberto Valente ◽  
Stefano Di Domenico ◽  
Matteo Mascherini ◽  
Gregorio Santori ◽  
Francesco Papadia ◽  
...  
Keyword(s):  
Elective Surgery ◽  
Waiting Lists ◽  
Waiting List ◽  
Service Capacity ◽  
Rapid Disease Progression ◽  
Prioritization Method ◽  
Access To Surgery ◽  
Selection Of Patients ◽  
Center Research ◽  
Selection Of

AbstractThe COVID-19 pandemic burdens non-covid elective surgical patients by reducing service capacity, forcing extreme selection of patients most in need. Our study assesses the SWALIS- 2020 model ability to prioritize access to surgery during the highest viral outbreak peaks.A 2020 March - May feasibility-pilot study tested a software-aided, inter-hospital, multidisciplinary pathway. All specialties patients in the Genoa Surgical Departments referred for urgent elective patients were prioritized by a modified Surgical Waiting List InfoSystem (SWALIS) cumulative prioritization method (PAT-2020) based on waiting time and clinical urgency, in three subcategories: A1-15 days (certain rapid disease progression), A2-21 days (probable progression), and A3-30 days (potential progression). We have studied the model’s applicability and its ability to prioritize patients by monitoring waiting list and service performance. https://www.isrctn.com/ISRCTN11384058.Following the feasibility study (N=55 patients), 240 referrals were evaluated in 4 weeks without major criticalities (M/F=73/167, Age=68.7 +/- 14.0). Waiting lists were prioritized and monitored. The SWALIS-2020 score (% of waited-against-maximum time) at operation was 88.7 +/- 45.2 at week 1 and then persistently over 100% (efficiency), over a controlled variation (equity), with a difference between A3 (153.29 +/- 103.52) vs. A1 (97.24 +/- 107.93) (p <0.001), and A3 vs. A2 (88.05 +/- 77.51) (p <0.001). 222 patients underwent surgery, without related complications or delayed/failed discharges.The pathway has selected the very few patients with the greatest need, even with +30% capacity weekly modifications, managing active and backlog waiting lists. We are looking for collaboration for multi-center research.

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