Time to wait: a systematic review of strategies that affect out-patient waiting times

Objective Out-patient waiting times pose a significant challenge for public patients in need of specialist evaluation and intervention. The aim of the present study was to identify and categorise effective strategies to reduce waiting times for specialist out-patient services with a focus on the Australian healthcare system. Methods A systematic review of major health databases was conducted using the key terms ‘outpatient*’ AND ‘waiting time’, ‘process*’ AND ‘improvement in outpatient clinics’. Identified articles were assessed for their relevance by sequential review of the title, abstract and full text. References of the selected manuscripts were scanned for additional relevant articles. Selected articles were evaluated for consistent and emerging themes. Results In all, 152 articles were screened, of which 38 were included in the present review. Numerous strategies identified in the articles were consolidated into 26 consistent approaches. Three overarching themes were identified as significantly affecting waiting times: resource realignment, operational efficiency and process improvement. Conclusions Strategies to align resources, increase operational efficiency and improve processes provide a comprehensive approach that may reduce out-patient waiting times. What is known about the topic? Out-patient waiting times are a challenge in most countries that seek to provide universal access to health care for all citizens. Although there has been extensive research in this area, many patients still experience extensive delays accessing specialist care, particularly in the public health sector. The multiple factors that contribute to bottlenecks and inefficiencies in the referral process and affect patient waiting times are often poorly understood. What does this paper add? This paper reviews the published healthcare literature to identify strategies that affect specialist out-patient waiting times for patients. The findings suggest that there are numerous operational strategies that affect waiting times. These strategies may be categorised into three overarching themes (resource alignment, operational efficiencies and out-patient processes) that, when actioned in a coordinated approach, have the potential to significantly reduce out-patient waiting times. What are the implications for practitioners? This paper identifies evidence-based strategies for aligning resources, improving operational efficiency and streamlining processes, which may provide improvements to specialist out-patient waiting times for patients. Addressing the identified organisational, person-related, cultural and attitudinal factors will assist health system managers and health practitioners target the most appropriate improvement activities to reduce waiting times.

Download Full-text

Efficient perioperative time-management methods for operating theatres: a systematic review showing how to reduce overall patient waiting times for elective surgery

10.21203/rs.3.rs-428636/v1 ◽

2021 ◽

Author(s):

Dimuthu Rathnayake

Keyword(s):

Systematic Review ◽

Time Management ◽

Elective Surgery ◽

Waiting Times ◽

Experimental Studies ◽

Cochrane Library ◽

Start Time ◽

Randomized Controlled Studies ◽

First Case ◽

Patient Waiting

Abstract Introduction: The effects on long waiting times for elective surgeries from lower operating theatre (OT) performance have been reported in many studies. The timeliness of perioperative processes and adherence to scheduled times is crucial for efficient performance in OT but the perioperative workflow includes multiple tasks assigned to different work teams. Each of these needs to be completed in a timely manner. This systematic review investigates the effects of efficient preoperative systems on the timeliness of upstream and downstream processes in surgical care pathways in order to reduce overall patient waiting times for elective surgery. Methods: We searched PubMed, EMBASE, SCOPUS, Web of Science and Cochrane Library databases during December 2019 and January 2020, for articles published after 1 January 2014. All studies pertaining to perioperative time-management methods, which had an intention to reduce waiting times for elective surgery were eligible for this review. Eligibility criteria included major elective surgery lists of adult patients, excluding cancer and cancer-related surgeries. Both randomized trials and non-randomized controlled studies were considered and the quality of studies was assessed using ROBINS-I and CASP tools. The review findings are presented as a narrative synthesis due to the heterogeneity of included studies. The PROSPERO registration is CRD42019158455. Results: The electronic search yielded 7543 records and 20 articles were eligible after deduplication and full article screening. There were two experimental studies, five quasi-experimental studies and 13 observational studies. The studies varied widely in design, scope, reported outcomes and overall quality. The first-case-start-time and patient change-over-time at OT were the main time related measures considered as affecting timeliness in many studies. Conclusion: This review suggests that a significant amount of time could be saved with efficient scheduling and planning perioperative processes, which could reduce overall patient waiting time for elective surgeries. Managing perioperative time in isolation could be an enabling factor for an overall increase in both theatre utilisation and theatre efficiency. However, only a small number of good quality studies were available and further evaluation with higher quality study designs and rigour is recommended in order for firm conclusions to be reached.

Download Full-text

Systematic review methodology for development: An example from microfinance

Africanus Journal of Development Studies ◽

10.25159/0304-615x/5079 ◽

2018 ◽

Vol 43 (1) ◽

pp. 65-77 ◽

Cited By ~ 2

Author(s):

Carina Van Rooyen ◽

Ruth Stewart ◽

Thea De Wet

Keyword(s):

Systematic Review ◽

International Development ◽

Health Sector ◽

Evidence Based ◽

Systematic Review Methodology ◽

Development Interventions ◽

The Us ◽

Sub Saharan ◽

The Impact ◽

Evidence Based Decision Making

Big international development donors such as the UK’s Department for International Development and USAID have recently started using systematic review as a methodology to assess the effectiveness of various development interventions to help them decide what is the ‘best’ intervention to spend money on. Such an approach to evidence-based decision-making has long been practiced in the health sector in the US, UK, and elsewhere but it is relatively new in the development field. In this article we use the case of a systematic review of the impact of microfinance on the poor in sub-Saharan African to indicate how systematic review as a methodology can be used to assess the impact of specific development interventions.

Download Full-text

Beveridge, Bismarck and Southern European Health Care Systems: Can We Decide Which is the Best in EU-15? A Statistical Analysis

European Journal of Medicine and Natural Sciences ◽

10.26417/ejmn.v1i1.p41-49 ◽

2017 ◽

Vol 1 (1) ◽

pp. 41

Author(s):

Angeliki Moisidou

Keyword(s):

Health Care ◽

Statistical Analysis ◽

Empirical Analysis ◽

Access To Health Care ◽

High Performance ◽

Social Protection ◽

Health Care Systems ◽

Health Sector ◽

Economic Cost ◽

Care Systems

A statistical analysis has been conducted with the aim to elucidate the effect of health care systems (HSs) on health inequalities assessed in terms of (a) differential access to health care services and (b) varying health outcomes among different models of HSs in EU-15 ((Beveridge: UK, IE, SE, FI, DK), (Bismarck: DE, FR, BE, LU, AT, NL), (Southern European model: GR, IT, ES, PT)). In the effort to interpret the results of the empirical analysis, we have ascertained systematic differences among the HSs in EU-15. Specifically, it is concluded that countries with Beveridge HS can be characterized more efficient (than average) in the most examined correlations, showing particularly high performance in the health sector. Similarly, countries with Bismarck HS record fairly satisfactory performance, but simultaneously they display more structural weaknesses compared with the Beveridge model. In addition, our empirical analysis has shown that adopting Bismarck model requires higher economic cost, compared with the Beveridge model, which is directly financed by taxation. On the contrary, in the countries with Southern European HS, the lowest performances are generally identified, which can be attributed to the residual social protection that characterizes these countries. The paper concludes with a synthesis of the empirical findings of our research. It proposes some directions for further research and presents a set of implications for policymakers regarding the planning and implementation of appropriate policies in order to tackle health inequality within HSs.

Download Full-text

What is Happening in the United States? How Social Classes Influence the Political Life of the Country and its Health and Quality of Life

International Journal of Health Services ◽

10.1177/0020731421994841 ◽

2021 ◽

pp. 002073142199484

Author(s):

Vicente Navarro

Keyword(s):

Quality Of Life ◽

United States ◽

Access To Health Care ◽

Universal Access ◽

The United States ◽

Political Context ◽

Political Life ◽

The Political ◽

Race And Gender

This article analyses the political changes that have been occurring in the United States (including the elections for the presidency of the country) and their consequences for the health and quality of life of the population. A major thesis of this article is that there is a need to analyse, besides race and gender, other categories of power - such as social class - in order to understand what happens in the country. While the class structure of the United States is similar to that of major Western European countries, the political context is very different. The U.S. political context has resulted in the very limited power of its working class, which explains the scarcity of labor, political and social rights in the country, such as universal access to health care.

Download Full-text

More than just contraception: the impact of the levonorgestrel-releasing intrauterine system on public health over 30 years

BMJ Sexual & Reproductive Health ◽

10.1136/bmjsrh-2020-200962 ◽

2021 ◽

pp. bmjsrh-2020-200962

Author(s):

Kristina Gemzell-Danielsson ◽

Ali Kubba ◽

Cecilia Caetano ◽

Thomas Faustmann ◽

Eeva Lukkari-Lax ◽

...

Keyword(s):

Unplanned Pregnancy ◽

Universal Access ◽

Waiting Times ◽

Hospital Environment ◽

Future Research ◽

Reproductive Health Services ◽

Therapeutic Benefits ◽

Cost Efficacy ◽

Long Acting ◽

The Impact

Universal access to sexual and reproductive health services is essential to facilitate the empowerment of women and achievement of gender equality. Increasing access to modern methods of contraception can reduce the incidence of unplanned pregnancy and decrease maternal mortality. Long-acting reversible contraceptives (LARCs) offer high contraceptive efficacy as well as cost-efficacy, providing benefits for both women and healthcare systems. The levonorgestrel-releasing intrauterine system (LNG-IUS) first became available in 1990 with the introduction of Mirena (LNG-IUS 20), a highly effective contraceptive which can reduce menstrual blood loss and provide other therapeutic benefits. The impact of the LNG-IUS on society has been wide ranging, including decreasing the need for abortion, reducing the number of surgical sterilisation procedures performed, as well as reducing the number of hysterectomies carried out for issues such as heavy menstrual bleeding (HMB). In the context of the COVID-19 pandemic, Mirena can provide a treatment option for women with gynaecological issues such as HMB without organic pathology, minimising exposure to the hospital environment and reducing waiting times for surgical appointments. Looking to the future, research and development in the field of the LNG-IUS continues to expand our understanding of these contraceptives in clinical practice and offers the potential to further expand the choices available to women, allowing them to select the option that best meets their needs.

Download Full-text

Estimating the local spatio‐temporal distribution of malaria from routine health information systems in areas of low health care access and reporting

International Journal of Health Geographics ◽

10.1186/s12942-021-00262-4 ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Elizabeth Hyde ◽

Matthew H. Bonds ◽

Felana A. Ihantamalala ◽

Ann C. Miller ◽

Laura F. Cordier ◽

...

Keyword(s):

Health Care ◽

Access To Health Care ◽

Malaria Incidence ◽

Universal Access ◽

Surveillance Systems ◽

Passive Surveillance ◽

Transmission Season ◽

Access To Health ◽

Spatio Temporal ◽

Geographic Access To Care

Abstract Background Reliable surveillance systems are essential for identifying disease outbreaks and allocating resources to ensure universal access to diagnostics and treatment for endemic diseases. Yet, most countries with high disease burdens rely entirely on facility-based passive surveillance systems, which miss the vast majority of cases in rural settings with low access to health care. This is especially true for malaria, for which the World Health Organization estimates that routine surveillance detects only 14% of global cases. The goal of this study was to develop a novel method to obtain accurate estimates of disease spatio-temporal incidence at very local scales from routine passive surveillance, less biased by populations' financial and geographic access to care. Methods We use a geographically explicit dataset with residences of the 73,022 malaria cases confirmed at health centers in the Ifanadiana District in Madagascar from 2014 to 2017. Malaria incidence was adjusted to account for underreporting due to stock-outs of rapid diagnostic tests and variable access to healthcare. A benchmark multiplier was combined with a health care utilization index obtained from statistical models of non-malaria patients. Variations to the multiplier and several strategies for pooling neighboring communities together were explored to allow for fine-tuning of the final estimates. Separate analyses were carried out for individuals of all ages and for children under five. Cross-validation criteria were developed based on overall incidence, trends in financial and geographical access to health care, and consistency with geographic distribution in a district-representative cohort. The most plausible sets of estimates were then identified based on these criteria. Results Passive surveillance was estimated to have missed about 4 in every 5 malaria cases among all individuals and 2 out of every 3 cases among children under five. Adjusted malaria estimates were less biased by differences in populations’ financial and geographic access to care. Average adjusted monthly malaria incidence was nearly four times higher during the high transmission season than during the low transmission season. By gathering patient-level data and removing systematic biases in the dataset, the spatial resolution of passive malaria surveillance was improved over ten-fold. Geographic distribution in the adjusted dataset revealed high transmission clusters in low elevation areas in the northeast and southeast of the district that were stable across seasons and transmission years. Conclusions Understanding local disease dynamics from routine passive surveillance data can be a key step towards achieving universal access to diagnostics and treatment. Methods presented here could be scaled-up thanks to the increasing availability of e-health disease surveillance platforms for malaria and other diseases across the developing world.

Download Full-text

The Impact of Internalized Stigma on LGBT Parenting and the Importance of Health Care Structures: A Qualitative Study

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18105373 ◽

2021 ◽

Vol 18 (10) ◽

pp. 5373

Author(s):

Carolina Alday-Mondaca ◽

Siu Lay-Lisboa

Keyword(s):

Health Care ◽

Access To Health Care ◽

Health Care Services ◽

Universal Access ◽

Civil Society Organizations ◽

Support Network ◽

Internalized Stigma ◽

Lgbt People ◽

Mental Health Programs ◽

The Impact

Research on LGBTIQ+ families has focused on the effects of being in a diverse family on the development of children. We seek to show the experience of parenthood from the perspective of LGBTIQ+ people, considering its particularities and the role that health care services play as a potential support network. We used the biographical method through open-ended interviews, participants were LGBT people, and key informants from Chile, Colombia, and Mexico were selected based on a sociostructural sampling. We found that internalized stigma impacts LGBTIQ+ parenting in five ways: the impossibility of thinking of oneself as a parent, fear of violating children’s rights, fear of passing on the stigma, fear of introducing their LGBTIQ+ partner, and the greater discrimination that trans and intersex people suffer. We identified gaps in health care perceptions: the need to guarantee universal access to health care, the need to include a gender perspective and inclusive treatment by health personnel, mental health programs with a community approach, access to assisted fertilization programs, and the generation of collaborative alliances between health services, civil society organizations, and the LGBTIQ+ community. We conclude that the health system is a crucial space from which to enable guarantees for the exercise of rights and overcome internalized stigma.

Download Full-text

Advocacy for a Digital Oral Health That Leaves No One Behind

JDR Clinical & Translational Research ◽

10.1177/23800844211026610 ◽

2021 ◽

pp. 238008442110266

Author(s):

N. Giraudeau ◽

B. Varenne

Keyword(s):

Health Care ◽

Oral Health ◽

Access To Health Care ◽

Universal Access ◽

Digital Health ◽

World Health ◽

Noncommunicable Diseases ◽

Central Component ◽

Health Coverage ◽

The Impact

During the first wave of the coronavirus disease 2019 (COVID-19) pandemic, the lockdown enforced led to considerable disruption to the activities of dental services, even leading to closures. To mitigate the impact of the lockdowns, systems were quickly put in place in most countries to respond to dental emergencies, giving priority to distance screening, advice to patients by remote means, and treatment of urgent cases while ensuring continuous care. Digital health was widely adopted as a central component of this new approach, leading to new practices and tools, which in turn demonstrated its potential, limitations, and possible excesses. Political leaders must become aware of the universal availability of digital technology and make use of it as an additional, safe means of providing services to the public. In view of the multiple uses of digital technologies in health—health literacy, teaching, prevention, early detection, therapeutics, and public health policies—deployment of a comprehensive program of digital oral health will require the adoption of a multifaceted approach. Digital tools should be designed to reduce, not increase, inequalities in access to health care. It offers an opportunity to improve healthy behavior, lower risk factors common to oral diseases and others noncommunicable diseases, and contribute to reducing oral health inequalities. It can accelerate the implementation of universal health coverage and help achieve the 2030 Sustainable Development Agenda, leaving no one behind. Digital oral health should be one of the pillars of oral health care after COVID-19. Universal access to digital oral health should be promoted globally. The World Health Organization’s mOralHealth program aims to do that. Knowledge Transfer Statement: This position paper could be used by oral health stakeholders to convince their government to implement digital oral health program.

Download Full-text

Dietary patterns before and during pregnancy and maternal outcomes: a systematic review

American Journal of Clinical Nutrition ◽

10.1093/ajcn/nqy216 ◽

2019 ◽

Vol 109 (Supplement_1) ◽

pp. 705S-728S ◽

Cited By ~ 11

Author(s):

Ramkripa Raghavan ◽

Carol Dreibelbis ◽

Brittany L Kingshipp ◽

Yat Ping Wong ◽

Barbara Abrams ◽

...

Keyword(s):

Systematic Review ◽

Health Care ◽

Dietary Patterns ◽

Access To Health Care ◽

Gestational Hypertension ◽

Controlled Trial ◽

Whole Grains ◽

Access To Health ◽

Caucasian Women ◽

Reduced Risk

ABSTRACT Background Hypertensive disorders of pregnancy (HDP) and gestational diabetes mellitus (GDM) are common maternal complications during pregnancy, with short- and long-term sequelae for both mothers and children. Objective Two systematic review questions were used to examine the relation between 1) dietary patterns before and during pregnancy, 2) HDP, and 3) GDM. Methods A search was conducted from January 1980 to January 2017 in 9 databases including PubMed, Embase, and Cochrane. Two analysts independently screened articles using a priori inclusion and exclusion criteria; data were extracted from included articles, and risk of bias was assessed. After qualitative synthesis, a conclusion statement was drafted for each question and the evidence supporting the conclusion was graded. Results Of the 9103 studies identified, 8 [representing 4 cohorts and 1 randomized controlled trial (RCT)] were included for HDP and 11 (representing 6 cohorts and 1 RCT) for GDM. Limited evidence in healthy Caucasian women with access to health care suggests dietary patterns before and during pregnancy that are higher in vegetables, fruits, whole grains, nuts, legumes, fish, and vegetable oils and lower in meat and refined grains are associated with reduced risk of HDP, including preeclampsia and gestational hypertension. Limited but consistent evidence suggests certain dietary patterns before pregnancy are associated with reduced risk of GDM. These protective dietary patterns are higher in vegetables, fruits, whole grains, nuts, legumes, and fish and lower in red and processed meats. Most of the research was conducted in healthy, Caucasian women with access to health care. Insufficient evidence exists on the associations between dietary patterns before and during pregnancy and risk of HDP in minority women and those of lower socioeconomic status, and dietary patterns during pregnancy and risk of GDM. Conclusions Although some conclusions were drawn from these systematic reviews, more research is needed to address gaps and limitations in the evidence.

Download Full-text