scholarly journals Modelling the recovery of elective waiting lists following COVID-19: scenario projections for England

2021 ◽  
Author(s):  
Nicholas C Howlett ◽  
Richard M Wood
Keyword(s):  
Computer Simulation ◽  
Patient Outcomes ◽  
Waiting Times ◽  
Waiting Lists ◽  
Waiting List ◽  
List Size ◽  
Worst Case ◽  
Indirect Impact ◽  
Scenario Projections

Background: A significant indirect impact of COVID-19 has been the increasing elective waiting times observed in many countries. In England's National Health Service, the waiting list has grown from 4.4 million in February 2020 to 5.7m by August 2021. Aims: The objective of this study was to estimate the trajectory of future waiting list size and waiting times to December 2025. Methods: A scenario analysis was performed using computer simulation and publicly available data as of November 2021. Future demand assumed a phased return of various proportions (0, 25, 50 and 75%) of the estimated 7.1 million referrals 'missed' during the pandemic. Future capacity assumed 90, 100 and 110% of that provided in the 12 months immediately before the pandemic. Results: As a worst case, the waiting list would reach 13.6m (95% CI: 12.4m to 15.6m) by Autumn 2022, if 75% of missed referrals returned and only 90% of pre pandemic capacity could be achieved. Under this scenario, the proportion of patients waiting under 18 weeks would reduce from 67.6% in August 2021 to 42.2% (37.4% to 46.2%) with the number waiting over 52 weeks reaching 1.6m (0.8m to 3.1m) by Summer 2023. At this time, 29.0% (21.3% to 36.8%) of patients would be leaving the waiting list before treatment. Waiting lists would remain pressured under even the most optimistic of scenarios considered, with 18-week performance struggling to maintain 60% (against the 92% constitutional target). Conclusions: This study reveals the long-term challenge for the NHS in recovering elective waiting lists as well as potential implications for patient outcomes and experience.

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.

The Overseas Service Veteran At Home Pilot: How Choice of Care May Affect Use of Nursing Home Beds and Waiting Lists

2004 ◽  
Vol 23 (4) ◽  
pp. 367-369 ◽  
Author(s):  
David Pedlar ◽  
John Walker
Keyword(s):  
Nursing Home ◽  
Military Service ◽  
Long Term Care ◽  
Waiting Times ◽  
Pilot Project ◽  
Waiting Lists ◽  
Term Care ◽  
Treatment Services ◽  
At Home

ABSTRACTIn 1999 Veterans Affairs Canada (VAC) implemented the Overseas Service Veterans (OSV) At Home Pilot Project in response to the problem that a growing number of clients were on waiting lists for beds in long-term care facilities. The At Home pilot offered certain clients on waiting lists, who met nursing-level care and military-service requirements, access to home care and treatment services for which they had previously been ineligible. A review of the pilot showed that a large majority of clients preferred to remain at home, with support, rather than accept a long-term care placement, even when a bed became available. The pilot has helped reduce waiting times for nursing home beds and may have important implications for reducing costs and the demand for long-term care beds.

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 Prompt laparoscopic cholecystectomy would reduce morbidity and save hospital resources

2014 ◽  
Vol 96 (4) ◽  
pp. 294-296 ◽  
Author(s):  
BWP Rossi ◽  
E Bassett ◽  
M Martin ◽  
S Andrews ◽  
S Wajed
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Elective Surgery ◽  
Waiting Times ◽  
Emergency Admission ◽  
Waiting List ◽  
Document Management ◽  
Document Management System ◽  
Patient Morbidity ◽  
Hospital Resources

Introduction Limited resources and organisational problems often result in significant waiting times for patients presenting with an indication for cholecystectomy. This study investigated the potential false economy of such practice. Methods Retrospective analysis of all patients on a waiting list for cholecystectomy between July 2007 and October 2010 was performed. The hospital computer document management system and patients’ notes were used to collect data. Results A total of 1,021 patients were included in the study; 701 were listed from clinic and 320 were listed following an emergency admission. The median time on a waiting list before surgery was 96 days (range: 5–381 days). Eighty-seven patients (8.5%) had an emergency admission with a gallstone related problem while on a waiting list. This resulted in 488 cumulative inpatient days. There was a significant correlation between increased time spent on the waiting list and increased chance of an emergency admission (p=0.01). Patients added to the waiting list from emergency admissions were more likely to be admitted with complications than those listed from clinic (15.3% vs 5.4%, p<0.01). There was no association between age (p=0.53) or sex (p=0.23) and likelihood of emergency admission while on a waiting list. Conclusions Prompt elective surgery and same-admission emergency laparoscopic cholecystectomy can reduce waiting list patient morbidity and is likely to save resources in the long term.

Analysis of public dental service waiting lists in Queensland

2015 ◽  
Vol 21 (1) ◽  
pp. 27 ◽  
Author(s):  
Ratilal Lalloo ◽  
Jeroen Kroon
Keyword(s):  
Low Income ◽  
Waiting Times ◽  
Open Data ◽  
Waiting Lists ◽  
Dental Service ◽  
Waiting List ◽  
Dental Services ◽  
Public Dental Service ◽  
Data Policy ◽  
The Impact

Information on public dental service waiting lists is available as part of the Queensland Government open data policy. Data were summarised across the care categories and health districts to present the total number and percentage of people waiting for care and who have waited beyond the desirable period. As of 31 December 2012 there were 130 546 people on the dental waiting list; of these 85.8%, 8.5% and 2.2% were waiting for general care desirable within 24, 12 and 3 months, respectively. Across all care categories, almost 56% of those on the waiting list were beyond the desirable waiting period. The average number of people on the waiting list and the average number waiting beyond the desirable time differ substantially per clinic by district. Ongoing analysis of the Queensland public dental service waiting list database will determine the impact on patient waiting times of Federal Government initiatives announced in 2012 to treat an estimated 400 000 patients on waiting lists nationwide over the next 3 years and to expand services to assist low-income adults to receive dental services.

scholarly journals Patient outcomes from time of listing for lung transplantation in the UK: are there disease-specific differences?

Thorax ◽  
2018 ◽  
Vol 74 (1) ◽  
pp. 60-68 ◽  
Author(s):  
Antonios Kourliouros ◽  
Rachel Hogg ◽  
Jenny Mehew ◽  
Mohamed Al-Aloul ◽  
Martin Carby ◽  
...  
Keyword(s):  
Lung Transplantation ◽  
Lung Disease ◽  
Blood Group ◽  
Patient Outcomes ◽  
Waiting Times ◽  
Patient Characteristics ◽  
Waiting List ◽  
Lung Pathology ◽  
Disease Category ◽  
The Uk

BackgroundThe demand for lung transplantation vastly exceeds the availability of donor organs. This translates into long waiting times and high waiting list mortality. We set out to examine factors influencing patient outcomes from the time of listing for lung transplantation in the UK, examining for differences by patient characteristics, lung disease category and transplant centre.MethodsData were obtained from the UK Transplant Registry held by NHS Blood and Transplant for adult lung-only registrations between 1January 2004 and 31 March 2014. Pretransplant and post-transplant outcomes were evaluated against lung disease category, blood group and height.ResultsOf the 2213 patient registrations, COPD comprised 28.4%, pulmonary fibrosis (PF) 26.2%, cystic fibrosis (CF) 25.4% and other lung pathologies 20.1%. The chance of transplantation after listing differed by the combined effect of disease category and centre (p<0.001). At 3 years postregistration, 78% of patients with COPD were transplanted followed by 61% of patients with CF, 59% of other lung pathology patients and 48% of patients with PF, who also had the highest waiting list mortality (37%). The chance of transplantation also differed by height with taller patients having a greater chance of transplant (HR: 1.03, 95% CI: 1.02 to 1.04, p<0.001). Patients with blood group O had the highest waiting mortality at 3 years postregistration compared with all other blood groups (27% vs 20%, p<0.001).ConclusionsThe way donor lungs were allocated in the UK resulted in discrepancies between the risk profile and probability of lung transplantation. A new donor lung allocation scheme was introduced in 2017 to try to address these shortcomings.

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 Does HLA matching matter in the modern era of renal transplantation?

2019 ◽  
Vol 36 (1) ◽  
pp. 31-40 ◽  
Author(s):  
Jon Jin Kim ◽  
Susan V Fuggle ◽  
Stephen D Marks
Keyword(s):  
Renal Transplantation ◽  
Patient Outcomes ◽  
Waiting Times ◽  
Surgical Techniques ◽  
Deceased Donor ◽  
Allograft Survival ◽  
Hla Matching ◽  
End Stage ◽  
Modern Era

AbstractChildren with end-stage kidney disease should be offered the best chance for future survival which ideally would be a well-matched pre-emptive kidney transplant. Paediatric and adult practice varies around the world depending on geography, transplant allocation schemes and different emphases on living (versus deceased) donor renal transplantation. Internationally, paediatric patients often have priority in allocation schemes and younger donors are preferentially allocated to paediatric recipients. HLA matching can be difficult and may result in longer waiting times. Additionally, with improved surgical techniques and modern immunosuppressive regimens, how important is the contribution of HLA matching to graft longevity? In this review, we discuss the relative importance of HLA matching compared with donor quality; and long-term patient outcomes including re-transplantation rates. We share empirical evidence that will be useful for clinicians and families to make decisions about best donor options. We discuss why living donation still provides the best allograft survival outcomes and what to do in the scenario of a highly mismatched living donor.

The effect of independent treatment centres on patient case mix within orthopaedic waiting lists

2006 ◽  
Vol 88 (8) ◽  
pp. 276-278
Author(s):  
BJ Bolland ◽  
C Corbin ◽  
IJ Bissell ◽  
JM Latham
Keyword(s):  
Patient Outcome ◽  
General Hospital ◽  
Waiting Times ◽  
Waiting Lists ◽  
Current Drive ◽  
Waiting List ◽  
Case Mix ◽  
Patient Case ◽  
Hospital Resources ◽  
Routine Procedures

There is concern that the current drive to reduce waiting lists and promote alternative providers, such as independent sector treatment centres (ISTCs), will lead to a change in the case mix of patients remaining on the waiting lists of local hospitals. The reallocation of routine procedures on medically fit patients to alternative providers will result in an increase in the proportion of complex or medically unwell patients remaining on a Trust's waiting list. Overall waiting times for routine surgery will be reduced but there are concerns about the uncertain effects on patient outcome, general hospital resources and the experience of orthopaedic trainees.

scholarly journals Waiting list eradication in serious mental illness (SMI) “secondary care” psychology: addressing an NHS blind spot

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S306-S306
Author(s):  
Nicola Airey ◽  
Zaffer Iqbal ◽  
Sophie Brown
Keyword(s):  
Mental Health ◽  
Secondary Care ◽  
Waiting Times ◽  
Blind Spot ◽  
Waiting Lists ◽  
Psychological Services ◽  
Waiting List ◽  
North East ◽  
Psychology Service

AimsThe poster focuses on the reduction, and eventual eradication, of waiting times within a community-based NHS psychology service in the North East of England. The poster aims to demonstrate the effectiveness of strategies implemented within a secondary care psychology service whilst examining patterns of help-seeking behaviour and treatment compliance in those waiting for therapy, and also the care needs of this cohort following a wait for services.BackgroundSecondary care waiting lists for psychological therapy, as highlighted by a recent British Medical Association audit, remain a so-called ‘blind-spot’ in mental health care provision and a national problem. Tackling waiting lists within this sector has been stated as a priority within the Five Year Forward View, however “core ingredients” of waiting list eradication methodologies and the components leading to such, have yet to be disseminated.MethodA historical audit and follow-up of clinical data were utilised to gather and analyse data of 208 individuals who were seen by the psychology service between October 2014 and March 2016.ResultNo significant differences were found between individuals who successfully completed therapy compared to those who disengaged in regard to demographic or epidemiological variables, or mental health service input. Despite lengthy waiting times of up to 3.69 years, waiting time did not significantly impact whether someone engaged with psychological services. Any form of input from psychological services led to a significant reduction in distress, as measured by the CORE-OM. No individuals who completed therapy were re-referred for psychological input at 12-month follow-up.ConclusionIf imposed appropriately over a suitable time-frame evidence-based, effective and efficient needs-led psychological input can be provided whilst eradicating a waiting list and still remaining flexible, formulation-based and person-centred.

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