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Pazin-Filho A, do Valle Dallora MEL, Velasco TR, Cardoso Dos Santos RDO, Volpe GJ, Moroço DM, de Souza DA, Canabrava CM, Garcia LV, Joviliano EE, Maciel BC. Surgical waiting lists and queue management in a Brazilian tertiary public hospital. BMC Health Serv Res 2024; 24:290. [PMID: 38448876 PMCID: PMC10916210 DOI: 10.1186/s12913-024-10735-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 02/15/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND Centralized management of queues helps to reduce the surgical waiting time in the publicly funded healthcare system, but this is not a reality in the Brazilian Unified Healthcare System (BUHS). We describe the implementation of the "Patients with Surgical Indication" (PSI) in a Brazilian public tertiary hospital, the impact on waiting time, and its use in rationing oncological surgeries during the COVID-19 Pandemic. METHODS Retrospective observational study of elective surgical requests (2016-2022) in a Brazilian general, public, tertiary university hospital. We recovered information regarding the inflows (indications), outflows and their reasons, the number of patients, and waiting time in queue. RESULTS We enrolled 82,844 indications in the PSI (2016-2022). The waiting time (median and interquartile range) in days decreased from 98(48;168) in 2016 to 14(3;152) in 2022 (p < 0.01). The same occurred with the backlog that ranged from 6,884 in 2016 to 844 in 2022 (p < 001). During the Pandemic, there was a reduction in the number of non-oncological surgeries per month (95% confidence interval) of -10.9(-18.0;-3.8) during Phase I (January 2019-March 2020), maintenance in Phase II (April 2020-August 2021) 0.1(-10.0;10.4) and increment in Phase III (September 2021-December 2022) of 23.0(15.3;30.8). In the oncological conditions, these numbers were 0.6(-2.1;3.3) for Phase I, an increase of 3.2(0.7;5.6) in Phase II and 3.9(1,4;6,4) in Phase III. CONCLUSION Implementing a centralized list of surgical indications and developing queue management principles proved feasible, with effective rationing. It unprecedentedly demonstrated the decrease in the median waiting time in Brazil.
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Affiliation(s)
- Antonio Pazin-Filho
- Ribeirão Preto Medical School, University of São Paulo, Ribeirao Preto, São Paulo, Brazil.
| | | | - Tonicarlo Rodrigues Velasco
- Clinical Hospital - Ribeirão Preto Medical School, University of São Paulo, Ribeirao Preto, São Paulo, Brazil
| | | | - Gustavo Jardim Volpe
- Clinical Hospital - Ribeirão Preto Medical School, University of São Paulo, Ribeirao Preto, São Paulo, Brazil
| | - Diego Marques Moroço
- Clinical Hospital - Ribeirão Preto Medical School, University of São Paulo, Ribeirao Preto, São Paulo, Brazil
| | - Danilo Arruda de Souza
- Clinical Hospital - Ribeirão Preto Medical School, University of São Paulo, Ribeirao Preto, São Paulo, Brazil
| | | | - Luis Vicente Garcia
- Ribeirão Preto Medical School, University of São Paulo, Ribeirao Preto, São Paulo, Brazil
| | | | - Benedito Carlos Maciel
- Ribeirão Preto Medical School, University of São Paulo, Ribeirao Preto, São Paulo, Brazil
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Mulholland C, Soliman C, Furrer MA, Sathianathen N, Corcoran NM, Schramm B, Mertens E, Peters J, Costello A, Lawrentschuk N, Dundee P, Thomas B. Same day discharge for robot-assisted radical prostatectomy: a prospective cohort study documenting an Australian approach. ANZ J Surg 2023; 93:669-674. [PMID: 36637213 DOI: 10.1111/ans.18198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 11/28/2022] [Accepted: 11/29/2022] [Indexed: 01/14/2023]
Abstract
BACKGROUND The introduction of robotic surgical systems has significantly impacted urological surgery, arguably more so than other surgical disciplines. The focus of our study was length of hospital stay - patients have traditionally been discharged day 1 post-robot-assisted radical prostatectomy (RARP), however, during the ongoing COVID-19 pandemic and consequential resource limitations, our centre has facilitated a cohort of same-day discharges with initial success. METHODS We conducted a prospective tertiary single-centre cohort study of a series of all patients (n = 28) - undergoing RARP between January and April 2021. All patients were considered for a day zero discharge pathway which consisted of strict inclusion criteria. At follow-up, each patient's perspective on their experience was assessed using a validated post-operative satisfaction questionnaire. Data were reviewed retrospectively for all those undergoing RARP over the study period, with day zero patients compared to overnight patients. RESULTS Overall, 28 patients 20 (71%) fulfilled the objective criteria for day zero discharge. Eleven patients (55%) agreed pre-operatively to day zero discharge and all were successfully discharged on the same day as their procedure. There was no statistically significant difference in age, BMI, ASA, Charlson score or disease volume. All patients indicated a high level of satisfaction with their procedure. Median time from completion of surgery to discharge was 426 min (7.1 h) in the day zero discharge cohort. CONCLUSION Day zero discharge for RARP appears to deliver high satisfaction, oncological and safety outcomes. Therefore, our study demonstrates early success with unsupported same-day discharge in carefully selected and pre-counselled patients.
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Affiliation(s)
- Clancy Mulholland
- Department of Urology, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Christopher Soliman
- Department of Urology, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Marc A Furrer
- Department of Urology, The Royal Melbourne Hospital, Parkville, Victoria, Australia
- Department of Urology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Department of Surgery, Royal Melbourne Hospital, University of Melbourne, The Australian Medical Robotics Academy, Melbourne, Victoria, Australia
| | | | - Niall M Corcoran
- Department of Urology, The Royal Melbourne Hospital, Parkville, Victoria, Australia
- Department of Surgery, University of Melbourne, Parkville, Victoria, Australia
| | - Belinda Schramm
- Department of Anaesthesia, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Evie Mertens
- Department of Urology, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Justin Peters
- Department of Urology, The Royal Melbourne Hospital, Parkville, Victoria, Australia
- Department of Surgery, Royal Melbourne Hospital, University of Melbourne, The Australian Medical Robotics Academy, Melbourne, Victoria, Australia
- Department of Surgery, University of Melbourne, Parkville, Victoria, Australia
| | - Anthony Costello
- Department of Urology, The Royal Melbourne Hospital, Parkville, Victoria, Australia
- Department of Surgery, Royal Melbourne Hospital, University of Melbourne, The Australian Medical Robotics Academy, Melbourne, Victoria, Australia
- Department of Surgery, University of Melbourne, Parkville, Victoria, Australia
| | - Nathan Lawrentschuk
- Department of Urology, The Royal Melbourne Hospital, Parkville, Victoria, Australia
- Department of Surgery, University of Melbourne, Parkville, Victoria, Australia
| | - Philip Dundee
- Department of Urology, The Royal Melbourne Hospital, Parkville, Victoria, Australia
- Department of Surgery, Royal Melbourne Hospital, University of Melbourne, The Australian Medical Robotics Academy, Melbourne, Victoria, Australia
- Department of Surgery, University of Melbourne, Parkville, Victoria, Australia
| | - Benjamin Thomas
- Department of Urology, The Royal Melbourne Hospital, Parkville, Victoria, Australia
- Department of Surgery, Royal Melbourne Hospital, University of Melbourne, The Australian Medical Robotics Academy, Melbourne, Victoria, Australia
- Department of Surgery, University of Melbourne, Parkville, Victoria, Australia
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Li H, Baldwin E, Zhang X, Kenost C, Luo W, Calhoun EA, An L, Bennett CL, Lussier YA. Comparison and impact of COVID-19 for patients with cancer: a survival analysis of fatality rate controlling for age, sex and cancer type. BMJ Health Care Inform 2021; 28:e100341. [PMID: 33980502 PMCID: PMC8117441 DOI: 10.1136/bmjhci-2021-100341] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 04/08/2021] [Accepted: 04/20/2021] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVES Prior research has reported an increased risk of fatality for patients with cancer, but most studies investigated the risk by comparing cancer to non-cancer patients among COVID-19 infections, where cancer might have contributed to the increased risk. This study is to understand COVID-19's imposed HR of fatality while controlling for covariates, such as age, sex, metastasis status and cancer type. METHODS We conducted survival analyses of 4606 cancer patients with COVID-19 test results from 16 March to 11 October 2020 in UK Biobank and estimated the overall HR of fatality with and without COVID-19 infection. We also examined the HRs of 13 specific cancer types with at least 100 patients using a stratified analysis. RESULTS COVID-19 resulted in an overall HR of 7.76 (95% CI 5.78 to 10.40, p<10-10) by following 4606 patients with cancer for 21 days after the tests. The HR varied among cancer type, with over a 10-fold increase in fatality rate (false discovery rate ≤0.02) for melanoma, haematological malignancies, uterine cancer and kidney cancer. Although COVID-19 imposed a higher risk for localised versus distant metastasis cancers, those of distant metastases yielded higher overall fatality rates due to their multiplicative effects. DISCUSSION The results confirmed prior reports for the increased risk of fatality for patients with COVID-19 plus hematological malignancies and demonstrated similar findings of COVID-19 on melanoma, uterine, and kidney cancers. CONCLUSION The results highlight the heightened risk that COVID-19 imposes on localised and haematological cancer patients and the necessity to vaccinate uninfected patients with cancer promptly, particularly for the cancer types most influenced by COVID-19. Results also suggest the importance of timely care for patients with localised cancer, whether they are infected by COVID-19 or not.
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Affiliation(s)
- Haiquan Li
- Department of Biosystems Engineering, The University of Arizona, Tucson, Arizona, USA
| | - Edwin Baldwin
- Department of Biosystems Engineering, The University of Arizona, Tucson, Arizona, USA
| | - Xiang Zhang
- Department of Biosystems Engineering, The University of Arizona, Tucson, Arizona, USA
| | - Colleen Kenost
- Department of Biomedical Informatics, The University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Wenting Luo
- Department of Biosystems Engineering, The University of Arizona, Tucson, Arizona, USA
| | - Elizabeth A Calhoun
- Department of Population Health, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Lingling An
- Department of Biosystems Engineering, The University of Arizona, Tucson, Arizona, USA
| | - Charles L Bennett
- Department of Clinical Pharmacy and Outcomes Sciences, University of South Carolina, Columbia, South Carolina, USA
| | - Yves A Lussier
- Department of Biomedical Informatics, The University of Utah School of Medicine, Salt Lake City, Utah, USA
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