scholarly journals The Effectiveness of Different Patient Referral Methods on Waiting Times for Adults Needing Elective Surgery - Systematic Review

2020 ◽  
Author(s):  
Dimuthu Rathnayake ◽  
Mike Clarke
Keyword(s):  
Primary Care ◽  
Waiting Time ◽  
Elective Surgery ◽  
Waiting Times ◽  
Surgical Care ◽  
Surgical Patients ◽  
Cochrane Library ◽  
Outcome Variable ◽  
Timely Access

Abstract Background: Long waiting times and lengthy queues for elective surgery are common to many publicly funded health systems. Primary care practitioners play a major role in determining which patients are referred to the consultant surgeon and might represent an opportunity to improve this situation. With conventional methods of referrals, surgery clinics are often overcrowded with non-surgical referrals and surgical patients experience longer waiting times as a consequence. Improving the quality of referral communications should lead to more timely access and better cost-effectiveness for elective surgical care. This review summarises the research evidence for interventions within the scope of primary care referral methods in the surgical care pathway that might shorten waiting time for elective surgeries.Methods: We searched PubMed, EMBASE, SCOPUS, Web of Science and Cochrane Library databases in December 2019 to January 2020, for articles published after 2013. Eligibility criteria included major elective surgery lists of adult patients, excluding cancer and cancer related surgeries. Randomised trials and non-randomised controlled studies were eligible. The main outcome variable of interest was waiting time for the elective surgery. The quality of evidence was assessed using ROBINS-I, AMSTAR 2 and CASP, as appropriate to the study method used. The review presentation was limited to a narrative synthesis because of heterogeneity. The PROSPERO registration number is CRD42019158455.Results: The electronic search yielded 7543 records. Finally, nine articles were considered as eligible after deduplication and full article screening. The eligible research varied widely in design, scope, reported outcomes and overall quality, with one randomised trial, two quasi-experimental studies, two longitudinal follow up studies, three systematic reviews and one observational study. The included research showed that patient triage and prioritisation at the referral stage improved timely access and increased the number of consultations of surgical patients in clinics.Conclusions: The available studies included a variety of interventions and were of medium to high quality, showing that methods to improve the management of primary care referrals of patients for elective surgery can reduce waiting times and shorten waiting lists for elective surgery for adults.

scholarly journals The effectiveness of different patient referral systems to shorten waiting times for elective surgeries: systematic review

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Dimuthu Rathnayake ◽  
Mike Clarke
Keyword(s):  
Primary Care ◽  
Health Systems ◽  
Elective Surgery ◽  
Waiting Times ◽  
Surgical Care ◽  
High Income ◽  
Surgical Patients ◽  
Timely Access ◽  
Referral Systems

Abstract Background Long waiting times for elective surgery are common to many publicly funded health systems. Inefficiencies in referral systems in high-income countries are more pronounced than lower and middle-income countries. Primary care practitioners play a major role in determining which patients are referred to surgeon and might represent an opportunity to improve this situation. With conventional methods of referrals, surgery clinics are often overcrowded with non-surgical referrals and surgical patients experience longer waiting times as a consequence. Improving the quality of referral communications should lead to more timely access and better cost-effectiveness for elective surgical care. This review summarises the research evidence for effective interventions within the scope of primary-care referral methods in the surgical care pathway that might shorten waiting time for elective surgeries. Methods We searched PubMed, EMBASE, SCOPUS, Web of Science and Cochrane Library databases in December-2019 to January-2020, for articles published after 2013. Eligibility criteria included major elective surgery lists of adult patients, excluding cancer related surgeries. Both randomised and non-randomised controlled studies were eligible. The quality of evidence was assessed using ROBINS-I, AMSTAR 2 and CASP, as appropriate to the study method used. The review presentation was limited to a narrative synthesis because of heterogeneity. The PROSPERO registration number is CRD42019158455. Results The electronic search yielded 7543 records. Finally, nine articles were considered as eligible after deduplication and full article screening. The eligible research varied widely in design, scope, reported outcomes and overall quality, with one randomised trial, two quasi-experimental studies, two longitudinal follow up studies, three systematic reviews and one observational study. All the six original articles were based on referral methods in high-income countries. The included research showed that patient triage and prioritisation at the referral stage improved timely access and increased the number of consultations of surgical patients in clinics. Conclusions The available studies included a variety of interventions and were of medium to high quality researches. Managing patient referrals with proper triaging and prioritisation using structured referral formats is likely to be effective in health systems to shorten the waiting times for elective surgeries, specifically in high-income countries.

scholarly journals Medicines Related Problems (MRPs) Originating in Primary Care Settings in Older Adults - A Systematic Review

2021 ◽  
pp. 089719002110236
Author(s):  
Rosetta Chinyere Ude-Okeleke ◽  
Zoe Aslanpour ◽  
Soraya Dhillon ◽  
Nkiruka Umaru
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Library Science ◽  
Cochrane Library ◽  
Inclusion Criteria ◽  
Data Bases ◽  
Primary Care Settings ◽  
Preventative Interventions ◽  
Use Of Health Services

Background: As people age, they become increasingly vulnerable to the untoward effects of medicines due to changes in body systems. These may result in medicines related problems (MRPs) and consequent decline or deterioration in health. Aim: To identify MRPs, indicators of deterioration associated with these MRPs, and preventative interventions from the literature. Design and Setting: Systematic review of primary studies on MRPs originating in Primary Care in older people. Methods: Relevant studies published between 2001 and April 2018 were obtained from Medline (via PubMed), CINAHL, Embase, Psych Info, PASCAL, Scopus, Cochrane Library, Science Direct, and Zetoc. Falls, delirium, pressure ulcer, hospitalization, use of health services and death were agreed indicators of deterioration. The methodological quality of included studies was assessed using the Down and Black tool. Results: There were 1858 articles retrieved from the data bases. Out of these, 21 full text articles met inclusion criteria for the review. MRPs identified were medication error, potentially inappropriate medicines, adverse drug reaction and non-adherence. These were associated with indicators of deterioration. Interventions that involved doctors, pharmacists and patients in planning and implementation yielded benefits in halting MRPs. Conclusion: This Systematic review summarizes MRPs and associated indicators of deterioration. Appropriate interventions appeared to be effective against certain MRPs and their consequences. Further studies to explore deterioration presented in this systematic review is imperative.

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 Improving the waiting times within a hospice breathlessness service

2019 ◽  
Vol 8 (2) ◽  
pp. e000582
Author(s):  
Caroline Sime ◽  
Stuart Milligan ◽  
Kevin Donal Rooney
Keyword(s):  
Palliative Care ◽  
Quality Improvement ◽  
Waiting Time ◽  
Current System ◽  
Waiting Times ◽  
Well Being ◽  
Common Symptom ◽  
Specialist Palliative Care ◽  
Published Evidence

BackgroundBreathlessness, a common symptom in advanced disease, is a distressing, complex symptom that can profoundly affect the quality of one’s life. Evidence suggests that specialist palliative care breathlessness intervention services can improve physical well-being, personal coping strategies and quality of life. In the UK, the use of quality improvement methods is well documented in the National Health Service. However, within the independent hospice sector there is a lack of published evidence of using such methods to improve service provision.AimThe aim of this project was to reduce the waiting time from referral to service commencement for a hospice breathlessness service by 40%—from a median of 19.5 to 11.5 working days.MethodsUsing a quality planning and systems thinking approach staff identified barriers and blockages in the current system and undertook plan-do-study-act cycles to test change ideas. The ideas tested included offering home visits to patients on long-term oxygen, using weekly team ‘huddles’, streamlining the internal referral process and reallocating staff resources.ResultsUsing quality improvement methods enabled staff to proactively engage in positive changes to improve the service provided to people living with chronic breathlessness. Offering alternatives to morning appointments; using staff time more efficiently and introducing accurate data collection enabled staff to monitor waiting times in real time. The reduction achieved in the median waiting time from referral to service commencement exceeded the project aim.ConclusionsThis project demonstrates that quality improvement methodologies can be successfully used in a hospice setting to improve waiting times and meet the specific needs of people receiving specialist palliative care.

scholarly journals Measuring and Analyzing Waiting Time Indicators of Patients’ Admitted in Emergency Department: A Case Study

2015 ◽  
Vol 8 (1) ◽  
pp. 143 ◽  
Author(s):  
Saeed Amina ◽  
Ahmad Barrati ◽  
Jamil Sadeghifar ◽  
Marzeyh Sharifi ◽  
Zahra Toulideh ◽  
...  
Keyword(s):  
Emergency Department ◽  
Waiting Time ◽  
Waiting Times ◽  
Hospital Data ◽  
Governance System ◽  
Cross Sectional ◽  
Average Waiting Time ◽  
Study Population

<p><strong>BACKGROUND</strong><strong> </strong><strong>&amp;</strong><strong> </strong><strong>AIMS:</strong> Measuring and analyzing of provided services times in Emergency Department is the way to improves quality of hospital services. The present study was conducted with aim measuring and analyzing patients waiting time indicators in Emergency Department in a general hospital in Iran.</p> <p><strong>MATERIAL</strong><strong> </strong><strong>&amp;</strong><strong> </strong><strong>METHODS:</strong> This cross-sectional, observational study was conducted during April to September 2012. The study population consisted of 72 patients admitted to the Emergency Department at Baharlo hospital. Data collection was carried out by workflow forms. Data were analyzed by t.<strong> </strong>test and ANOVA.</p> <p><strong>RESULTS:</strong> The average waiting time for patients from admission to enter the triage 5 minutes, the average time from triage to physician visit 6 minute and the average time between examinations to leave ED was estimated 180 minutes. The total waiting time in the emergency department was estimated at about 210 minutes. The significant<strong> </strong>correlation between marital status of patients (P=0.03), way of arrive to ED (P=0.02) and type of shift work (P=0.01) with studied time indicators were observed.</p> <p><strong>CONCLUSION:</strong> According to results and comparing with similar studies, the average waiting time of patients admitted to the studied hospital is appropriate. Factors such as: Utilizing clinical governance system and attendance of resident Emergency Medicine Specialist have performed an important role in reducing of waiting times in ED.</p>

Article Commentary: Optimizing Surgical Care: A Contemporary Assessment of Temperature, Oxygen, and Glucose

2010 ◽  
Vol 76 (6) ◽  
pp. 571-577 ◽  
Author(s):  
Ashley Dickinson ◽  
Motaz Qadan ◽  
Hiram C. Polk
Keyword(s):  
Immune Response ◽  
Quality Of Care ◽  
Innate Immune Response ◽  
Surgical Care ◽  
Innate Immune ◽  
Surgical Patients ◽  
Evidence Based

Factors such as temperature, oxygen, and glucose have recently been implicated in the development of surgical sepsis by either promoting or attenuating protective components of the innate immune response. Reducing infective sequelae and the improvement of the quality of care of surgical patients is a top practice priority today. These factors and their associated effects are discussed through the examination of recent clinical and scientific studies to provide an up-to-date evidence-based review.

scholarly journals Intestinal Ostomies Created During Emergency Surgery Possess Unique Challenges

2020 ◽  
Author(s):  
Wibke Schulte ◽  
Ilhamiyya Aliyeva ◽  
Michael Knoop ◽  
Johann Pratschke
Keyword(s):  
Emergency Surgery ◽  
Online Survey ◽  
Elective Surgery ◽  
Surgical Care ◽  
Wound Dehiscence ◽  
University Hospital ◽  
Complication Rates ◽  
Emergency Patients ◽  
Artificial Opening

Abstract Background: The surgical creation of an artificial opening of the bowel, called ostomy, can become necessary for very different causative diseases. A special subgroup are ostomies created during emergency surgery, which pose particular challenges to affected patients. This work is dedicated to their detailed characterization.Methods: A retrospective analysis of surgical ostomy creations at an acute care university hospital and an online survey for patients with an ostomy were performed and evaluated.Results: In our study, about one third of all ostomies were created during emergency surgery (37.4%). Compared to patients who received an ostomy during elective surgery, emergency patients had a higher ASA score and diagnoses requiring acute surgical care. Patients undergoing emergency surgery were more likely to have inadequate preoperative medical education (60% vs. 33.3%, p=0.029), and rarely received preoperative ostomy marking (4% vs. 79.2%, p<0.001). Emergency patients underwent minimally invasive surgery less frequently (26.8% vs. 51.3%, p=0.001), and showed a higher rate of peristomal wound dehiscence (9.9% vs. 2.5%, p=0.028). Accordingly, emergency ostomies often resulted in an overall reduction in postoperative quality of life.Conclusion: Ostomies are often created during emergency surgery under suboptimal perioperative conditions. This results in higher complication rates and negative physical and psychological effects. Therefore, intensive interdisciplinary care is essential to provide the best possible care for patients affected by these artificially created intestinal outlets.

scholarly journals Physical activity promotion for multimorbid patients in primary care settings: A protocol for a systematic review evaluating health benefits and harms.

2020 ◽  
Author(s):  
Simone Schweda ◽  
Inga Krauß
Keyword(s):  
Quality Of Life ◽  
Physical Activity ◽  
Systematic Review ◽  
Primary Care ◽  
Health Benefits ◽  
The Body ◽  
Cochrane Library ◽  
Primary Care Settings ◽  
Activity Promotion

Background: To date multimorbidity has not received much attention in health policies, even though multiple chronic diseases put high demands on the health care system in industrial nations. Enormous costs of care and a physically, mentally and socially reduced quality of life are common consequences of multimorbidity. Physical activity (PA) has a positive preventive and therapeutic effect on common non-communicable . The objective of this study will be to evaluate the halth benefits and harms of PA interventions for sedentary adults with multimorbidity in primary care settings. Methods: This is the study protocol for a systematic review. We will serach PubMed, MEDLINE (Ovid), Web of Science, CINHAL and the Cochrane Library (from inception onwards). In addition, clinical trial registers and reference lists of included studies will be searched. We will include randomised controlled trials, quasi-experimental and non-randomised trials examining the health benefits and harms of PA interventions with or without additional lifestyle interventions for sedentary adult patients with multimorbidity (e.g. two or more chronic non-communicable diseases) in primary care. Eligible control groups will be standard care, placebo or medications. Two reviewers will independently screen all citations, abstracts data and full text articles. The primary outcomes will be health related quality of life and mortality. Secondary outcomes will include cardiovascular fitness, muscular strength and disease specific outcomes (e.g. depression score), biomarkers as well as control of metabolic risk factors (e.g. blood pressure, HBA1c, body weight) and any adverse event. The study methodological quality will be appraised using appropriate tools. If feasible, we will conduct random effects meta-analysis. Additional analyses will be conducted to explore the potential sources of heterogeneity (e.g. study design, geographical location, or type of intervention). Strength of the body of evidence will be assessed according to the Grading of Recommendations Assessment (GRADE). Discussion: This review will evaluate the evidence on health benefits and harms of PA interventions for sedentary adults with multimorbidity in primary care settings. We anticipate our findings to be of interest to patients, their families, caregivers and healthcare professionals in selecting and conducting optimal health promotion programs. Possible implications for further research will be discussed.

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.

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