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.

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.

scholarly journals Introducing a reserve waiting list initiative for elective general surgery at a District General Hospital

2019 ◽  
Vol 8 (3) ◽  
pp. e000745 ◽  
Author(s):  
Vaki Antoniou ◽  
Olivia Burke ◽  
Roland Fernandes
Keyword(s):  
General Hospital ◽  
General Surgery ◽  
Fast Track ◽  
Operating Time ◽  
District General Hospital ◽  
Waiting List ◽  
Related Factors ◽  
Simple Protocol ◽  
Significant Burden ◽  
Training Opportunities

Cancelled operations represent a significant burden on the National Health Service in terms of theatre efficiency, financial implications and lost training opportunities. Moreover, they carry considerable physical and psychological effects to patients and their relatives. Evidence has shown that up to 93% of cancelled operations are due to patient-related factors. An analysis at our District General Hospital revealed that approximately 18 operations are cancelled on the day of surgery each month. This equates to 27 hours of allocated operating time valued by the trust as £67 500, not being used effectively. This retrospective quality improvement report aims to reduce unused theatre time due to cancelled elective operations in general surgery theatres—thereby improving theatre efficiency and patient care. To ascertain the baseline number of cancelled operations, an initial review of theatre cases was undertaken. Further review was then completed after implementation of two improvements—a short notice surgical waiting list and fast track pre-assessment clinics. The results showed that implementation of the reserve surgical waiting list reduced unused operating time by an average of 2.25 hours per month. By further adding in the fast track preassessment clinic, these figures increased to an average of 11.5 hours over the next 3 months. This precipitated a reutilisation of otherwise wasted theatre time. Economic impact of this time amounts around £28 750 a month, after implementation of both improvements. Simple protocol changes can lead to large improvements in the efficient running of theatres. The resultant change has improved patient satisfaction, led to greater training opportunities and improved theatre efficiency. Extrapolation of our results show better usage of previously underused theatre time, to the equivalent worth of £345 000. Further implementation of these improvements in other surgical specialities and hospitals would be beneficial.

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.

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.

COST-UTILITY OF WAITING TIME IN TOTAL JOINT REPLACEMENTS: A RANDOMIZED CLINICAL TRIAL

2013 ◽  
Vol 29 (1) ◽  
pp. 27-34 ◽  
Author(s):  
Ulla Tuominen ◽  
Harri Sintonen ◽  
Pasi Aronen ◽  
Johanna Hirvonen ◽  
Seppo Seitsalo ◽  
...  
Keyword(s):  
Waiting Time ◽  
Elective Surgery ◽  
Waiting Times ◽  
High Volume ◽  
Developed Countries ◽  
The United States ◽  
Cost Utility ◽  
Joint Replacements ◽  
Total Joint Replacements ◽  
Mean Waiting Time

In many Western countries, long waiting times for elective surgery are a concern. Major joint replacement is an example of a type of surgery with a high volume of demand and relatively long waiting periods for patients. As populations get older, the prevalence of slowly progressive diseases, such as osteoarthritis (OA) in hip and knee joints, is increasing. Over three-quarters of a million total hip and knee replacement surgeries are done in the United States annually (1). Furthermore, according to March et al. (1997), the costs of OA have been estimated to account for up to 1–2.5 percent of the Gross National Product (GNP) in several developed countries (2). In Finland, a total of 11,104 total joint replacements (TJRs) were performed in 2004 (hip 6,600 and knee 5,905), with the median waiting time of 181 days for the surgery (hip 153 and knee 209 days). Until 2007, the number of TJRs was 17,334 (hip 7,698 and knee 9,636), with a median waiting time of 120 and 142 days, respectively (3;4). The mean waiting time for elective surgical procedures is approximately 3 months in several countries and the maximum waiting times can stretch into years.

scholarly journals The impact of the COVID-19 pandemic on waiting times for elective surgery patients: A multicenter study

PLoS ONE ◽  
2021 ◽  
Vol 16 (7) ◽  
pp. e0253875
Author(s):  
Mikko Uimonen ◽  
Ilari Kuitunen ◽  
Juha Paloneva ◽  
Antti P. Launonen ◽  
Ville Ponkilainen ◽  
...  
Keyword(s):  
Health Care ◽  
Waiting Time ◽  
Multicenter Study ◽  
Elective Surgery ◽  
Waiting Times ◽  
Public Hospitals ◽  
Mean Waiting Time ◽  
The Mean ◽  
The Impact ◽  
Surgery Incidence

Background A concern has been that health care reorganizations during the first COVID-19 wave have led to delays in elective surgeries, resulting in increased complications and even mortality. This multicenter study examined the changes in waiting times of elective surgeries during the COVID-19 pandemic in Finland. Methods Data on elective surgery were gathered from three Finnish public hospitals for years 2017–2020. Surgery incidence and waiting times were examined and the year 2020 was compared to the reference years 2017–2019. The mean annual, monthly, and weekly waiting times were calculated with 95% confidence intervals (CI). The most common diagnosis groups were examined separately. Findings A total of 88 693 surgeries were included during the study period. The mean waiting time in 2020 was 92.6 (CI 91.5–93.8) days, whereas the mean waiting time in the reference years was 85.8 (CI 85.1–86.5) days, resulting in an average 8% increase in waiting times in 2020. Elective procedure incidence decreased rapidly in the onset of the first COVID-19 wave in March 2020 but recovered in May and June, after which the surgery incidence was 22% higher than in the reference years and remained at this level until the end of the year. In May 2020 and thereafter until November, waiting times were longer with monthly increases varying between 7% and 34%. In gastrointestinal and genitourinary diseases and neoplasms, waiting times were longer in 2020. In cardiovascular and musculoskeletal diseases, waiting times were shorter in 2020. Conclusion The health care reorganizations due to the pandemic have increased elective surgery waiting times by as much as one-third, even though the elective surgery rate increased by one-fifth after the lockdown.

493 Evaluation of Patient Waiting Times for Plain Radiographs Whilst Attending Outpatient Clinics in A Tertiary Orthopaedic Centre

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
Z Hayat ◽  
E Kinene ◽  
S Molloy
Keyword(s):  
Waiting Time ◽  
Waiting Times ◽  
Time Frame ◽  
Outpatient Clinics ◽  
Contributing Factors ◽  
Time Data ◽  
Work Related ◽  
Mean Waiting Time ◽  
Appointment Time ◽  
Related Stress

Abstract Introduction Reduction of waiting times is key to delivering high quality, efficient health care. Delays experienced by patients requiring radiographs in orthopaedic outpatient clinics are well recognised. Method To establish current patient and staff satisfaction, questionnaires were circulated over a two-week period. Waiting time data was retrospectively collected including appointment time, arrival time and the time at which radiographs were taken. Results 84% (n = 16) of radiographers believed patients would be dissatisfied. However, of the 296 patients questioned, 56% (n = 165) were satisfied. Most patients (89%) felt the waiting time should be under 30 minutes. Only 36% were seen in this time frame. There was moderate negative correlation (R=-0.5); higher waiting times led to increased dissatisfaction. Mean waiting time was 00:37 and the maximum 02:48. Key contributing factors included volume of patients, staff shortages (73.7%), equipment shortages (57.9%) and incorrectly filled request forms. Eight (42.1%) had felt unwell from work related stress. Conclusions A concerted effort is needed to improve staff and patient opinion. There is scope for change post COVID. Additional training and exploring ways to avoid overburdening the department would benefit. Numerous patients were open to different days or alternative sites. Funding requirements make updating equipment, expanding the department and recruiting more staff challenging.

scholarly journals RADIOGRAPHIC IMPLICATIONS OF THE SURGICAL WAITING LIST FOR THE TREATMENT OF SPINAL DEFORMITY

2018 ◽  
Vol 17 (1) ◽  
pp. 19-22
Author(s):  
LEONARDO YUKIO JORGE ASANO ◽  
MARINA ROSA FILÉZIO ◽  
MATEUS PIPPA DEFINO ◽  
VINÍCIUS ALVES DE ANDRADE ◽  
ANDRÉ EVARISTO MARCONDES CESAR ◽  
...  
Keyword(s):  
Surgical Planning ◽  
Negative Impact ◽  
Waiting Times ◽  
Waiting List ◽  
Surgical Morbidity ◽  
Level Of Evidence ◽  
Mean Waiting Time ◽  
Significant Negative Impact ◽  
Double Approach ◽  
The Mean

ABSTRACT Objective: The aim of this study was to evaluate the implications of long waiting times on surgery lists for the treatment of patients with scoliosis. Methods: Radiographs of 87 patients with scoliosis who had been on the waiting list for surgery for more than six months were selected. Two surgeons answered questionnaires analyzing the radiographs when entering the waiting list and the current images of each patient. Results: Data from 87 patients were analyzed. The mean waiting time for surgery was 21.7 months (ranging from seven to 32 months). The average progression of the Cobb angle in the curvature was 21.1 degrees. Delayed surgery implied changes in surgical planning, such as greater need of instrumentation, osteotomies, and double approach. Conclusions: Long waiting lists have a significant negative impact on surgical morbidity of patients with scoliosis, since they increase the complexity of the surgery. Level of evidence: IV. Type of study: Descriptive study.

Cancellation of elective surgery – any improvement after ten years?

2006 ◽  
Vol 88 (1) ◽  
pp. 28-30 ◽  
Author(s):  
XL Griffin ◽  
DR Griffin ◽  
AR Berry ◽  
DC Hunter
Keyword(s):  
Resource Management ◽  
General Hospital ◽  
Elective Surgery ◽  
District General Hospital ◽  
Waiting List ◽  
Admission Process

Cancellation of elective operations represents a waste of resources and a poor standard of service to patients who may already have spent several months on a waiting list. The purpose of this study was to determine the extent of the problem in a typical district general hospital, how it has changed over a period of ten years and whether alterations in resource management in the admission process have led to improvements in service.

What do patients do before it starts? Coping with mental health problems on a CBT waiting list

2008 ◽  
Vol 1 (1) ◽  
pp. 45-54 ◽  
Author(s):  
Sylvia Helbig ◽  
Jürgen Hoyer
Keyword(s):  
Health Care ◽  
Health Care Utilization ◽  
Coping Strategies ◽  
Waiting Time ◽  
Waiting List ◽  
Care Utilization ◽  
Passive Coping ◽  
Self Help ◽  
Mean Waiting Time ◽  
Wide Range

AbstractData from a patient survey on self-help and coping strategies during waiting time for CBT are reported. Individuals on an outpatient treatment centre waiting list received a short questionnaire assessing problem-related activities carried out in the interval before therapy (mean waiting time 69 days). A total of 306 patients with a wide range of reliably diagnosed mental disorders were assessed. Results showed that the vast majority of patients (~95%) instigated at least one form of coping or self-help activity related to their mental problem. Resource-orientated strategies were most often reported (88%), but ‘seeking information about the problem’ was also highly prevalent. About one third of persons reported additional health-care utilization. Higher rates of symptom distress and depression were associated with additional health-care utilization and with more passive coping strategies such as distraction. Active self-help strategies contributed to poorer depression outcome and were, thus, no indicator of good prognosis. Other coping strategies were not linked to outcome variables. It can be concluded that problem-related processes do start before treatment. A more systematic integration of self-help activities into the case-formulation and more systematic research on the related (motivational) processes are recommended.

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