Management of waiting lists needs sound data

Surgical waiting lists and queue management in a Brazilian tertiary public hospital

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.

The impact of public performance reporting on cancer elective surgery waiting times: a data linkage study

Background

Excessive waiting times for cancer elective surgery are a concern in publicly funded healthcare systems. Several countries including Australia have introduced healthcare reforms involving time-based targets and public performance reporting (PPR) of hospital data. However, there is mixed evidence of their benefits. We sought to examine the impact of targets and PPR of cancer elective surgery waiting times on access to breast, bowel and lung cancer elective surgery.

Methods

We analysed routinely-collected linked data on admissions and waiting times for patients aged 15 years or over (n = 199,885) who underwent cancer surgery in a public hospital in Victoria, Australia over a 10-year period. We conducted difference-in-differences analyses to compare waiting times before (2006–07 to 2011–12) and after (2012–13 to 2015–16) the introduction of PPR in meeting these targets.

Results

Across all cancer types, urgent patients were all treated within 30 days before and after PPR. Following PPR, there was a slight increase in the mean waiting times across all cancer types and urgency categories. Patients with lung cancer waited on average two and half days longer for treatment and patients with breast cancer waited on average half-a-day less. There was no effect of PPR on waiting times for patients with bowel cancer across urgency categories.

Conclusions

Our findings suggest that time-based targets and PPR had minimal impact on surgical waiting times. This may be due to reasonable waiting times prior to PPR, improved efficiency being masked by 20% growth in the population, lack of public knowledge that waiting times are publicly reported, or lack of real-time reporting to drive behavioural change. The use of generic elective surgery recommended waiting time measures for cancer is discussed.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-021-06132-w.

The comparability of emergency department waiting time performance data

OBJECTIVE

To examine whether the reported urgency mix of an emergency department's (ED's) patients is associated with its waiting time performance.

DESIGN AND SETTING

Cross-sectional analysis of data on patient urgency mix and hospital ED performance reported on the MyHospitals website for July 2009 - June 2010.

MAIN OUTCOME MEASURES

ED performance assessed as the proportion of patients whose care was initiated within the recommended time frame for each of four triage categories.

RESULTS

Data for 158 hospitals showed that EDs with a higher proportion of patients assigned to the emergency category have poorer waiting time performance, after adjusting for hospital characteristics. Conversely, EDs with a higher proportion of patients assigned to the non-urgent category perform better. If performance scores were adjusted for reported patient urgency mix and hospital peer group, mean adjustments would be modest in size (3.7-7.1 percentage points, depending on the category), but for individual EDs the differences could be large (as large as 31 percentage points) and hospital waiting time performance rankings would be substantively impacted.

CONCLUSION

Since ED performance is related to reported patient urgency mix, adjusting for casemix in the ED may be warranted to ensure valid comparisons between hospitals. Further investigation of the validity of performance measures and appropriate adjustment for differences in hospital and patient characteristics is required if public reporting is to meet its goals.

The active management of surgical waiting lists: a urological surgery case study

Elective surgery waiting list management is a major public healthcare issue. This case study describes an integrated multifaceted approach to waiting list management at Peninsula Health, a public health service in Victoria, Australia. At the commencement of this study it was recognised that several issues associated with the urological surgical service constituted potential clinical risk. These included: recall mechanisms for multiple surveillance procedures; significant resource deficits; and long surgery waiting times. Responding to these issues a multifaceted approach to wait list management was implemented including: audit; direct lines of communication between clinical and administrative staff; urgent caseload management; utilisation of the Elective Surgery Access Scheme; financial and resource analysis justifying the appointment of a full-time urologist, and the establishment of a urology service from a satellite campus; implementation of a recall database; development of an outpatient service; and commencement of a day surgery initiative. This approach yielded results that included a 67% reduction in the number of 'ready for care' patients and a 78% reduction in the number of patients classified as 'overdue for surgery'. Average wait time for semi-urgent and non-urgent patients reduced from 248 days to 180 days in the 10-month period.