Interventions to reduce waiting times for elective procedures.
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ABSTRACT:
SUBMITTER: Ballini L
PROVIDER: S-EPMC10835204 | biostudies-literature | 2015 Feb
REPOSITORIES: biostudies-literature
Publications
Interventions to reduce waiting times for elective procedures.
Ballini Luciana L Negro Antonella A Maltoni Susanna S Vignatelli Luca L Flodgren Gerd G Simera Iveta I Holmes Jane J Grilli Roberto R
The Cochrane database of systematic reviews 20150223 2
<h4>Background</h4>Long waiting times for elective healthcare procedures may cause distress among patients, may have adverse health consequences and may be perceived as inappropriate delivery and planning of health care.<h4>Objectives</h4>To assess the effectiveness of interventions aimed at reducing waiting times for elective care, both diagnostic and therapeutic.<h4>Search methods</h4>We searched the following electronic databases: Cochrane Effective Practice and Organisation of Care (EPOC) Gr ...[more]
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Project description:BackgroundGlobally, reduction of patient waiting time has been identified as one of the major characteristics of a functional health system. In South Africa, 83% of the general population visiting primary healthcare (PHC) facilities must contend with long waiting times, overcrowding, staff shortages, poor quality of care, an ineffective appointment booking system, and a lack of medication. These experiences may, in turn, affect how patients view service quality.MethodsThis scoping review was guided by Arksey and O'Malley methodological framework. The primary literature search of peer-reviewed and review articles was achieved through PubMed/MEDLINE, Google Scholar, Science Direct, and World Health Organization (WHO) library databases, using waiting times, outpatient departments, factors, interventions, and primary healthcare facilities as keywords. Two independent reviewers screened abstracts and full articles, using the set inclusion and exclusion criteria. We used NVIVO® version 10 software to facilitate thematic analysis of the results from included studies.ResultsFrom the initial 250 records screened, nine studies were eligible for inclusion in this scoping review. Seven papers identified the factors contributing to waiting time, and five papers mentioned effective interventions implemented to reduce waiting times within PHC facilities. Our analysis produced three (patient factors, staff factors, and administrative systems) and two (manual-based waiting time reduction systems and electronic-based waiting time reduction systems) main themes pertaining to factors contributing to long waiting times and interventions to reduce waiting times, respectively.ConclusionOur results revealed that the patients, staff, and administrative systems all contribute to long waiting times within the PHC facilities. Patient waiting times recorded a wider and more evenly spread patient arrival pattern after the identified interventions in our study were implemented. There is a need to constantly strategize on measures such as implementing the use of an electronic appointment scheduling system and database, improving staff training on efficient patient flow management, and regularly assessing and optimizing administrative processes. By continuously monitoring and adapting these strategies, PHC facility managers can create a more efficient and patient-centered healthcare experience.
| S-EPMC11338458 | biostudies-literature
Project description:BackgroundWaiting times for elective treatments, including elective surgery, are a source of public concern and therefore are on policy makers' agenda. The long waiting times have often been tackled through the allocation of additional resources, in an attempt to reduce them, but results are not straightforward. At the same time, researchers have reported wide geographical variations in the provision of elective care not driven by patient needs or preferences but by other factors. The paper analyses the relationship between waiting times and treatment rates for nine high-volume elective surgical procedures in order to support decision making regarding the availability of these services for the citizens. Using the framework already proposed for the diagnostic services, we identify different patterns that can be followed to align the supply with patient needs in the Italian context.MethodsAfter measuring the waiting times and the treatment rates for nine procedures in the 34 districts in Tuscany, we performed correlation analyses. Then, we plotted the results in a matrix cross-checking waiting times and rates. By doing so, we identified four different contexts that require a second step analysis to tackle unwarranted geographical variations and ensure timely care to patients. Finally, for each district and elective surgical procedure, we measured the economic impact of the different treatment rates in order to evaluate whether there are any supply criticalities and eventually some room for maneuver. We also included active and passive mobility of patients.ResultsThe results show a high degree of variation both in treatment rates and waiting times, especially for the orthopaedic procedures: knee replacement, knee arthroscopy and hip replacement. The analysis performed for the nine interventions shows that the 34 districts are in varying positions in the waiting time-treatment rate matrix, suggesting that there is no straightforward relationship between rates and waiting times. Each combination in the matrix may have different determinants that require healthcare managers to adopt diversified strategies. The decision making process needs to be supported by a two-level analysis: the first one to put in place the matrix that cross-checks waiting times and treatment rates, the second one to analyse the characteristics of each quadrant and the improvement actions that can be proposed.ConclusionsIn Italy, waiting times in elective surgical services are a main policy issue with a relevant geographical variation. Our analysis reveals that this variation is due to multiple elements. In order to avoid simplistic approaches that do not solve the problem but often lead to increased expenditure, policy makers and healthcare managers should follow a two-step strategy firstly identifying the type of context and secondly analysing the impact of elements such as resource productivity, resource availability, patients' preferences and care appropriateness. Only in some cases it is required to increase the service supply.
| S-EPMC6560774 | biostudies-literature
Project description:BackgroundPolicies assigning low-priority patients treatment delays for care, in order to make room for patients of higher priority arriving later, are common in secondary healthcare services today. Alternatively, each new patient could be granted the first available appointment. We aimed to investigate whether prioritisation can be part of the reason why waiting times for care are often long, and to describe how departments can improve their waiting situation by changing away from prioritisation.MethodsWe used patient flow data from 2015 at the Department of Otorhinolaryngology, Haukeland University Hospital, Norway. In Dynaplan Smia, Dynaplan AS, dynamic simulations were used to compare how waiting time, size and shape of the waiting list, and capacity utilisation developed with and without prioritisation. Simulations were started from the actual waiting list at the beginning of 2015, and from an empty waiting list (simulating a new department with no initial patient backlog).ResultsFrom an empty waiting list and with capacity equal to demand, waiting times were built 7 times longer when prioritising than when not. Prioritisation also led to poor resource utilisation and short-lived effects of extra capacity. Departments where prioritisation is causing long waits can improve their situation by temporarily bringing capacity above demand and introducing "first come, first served" instead of prioritisation.ConclusionA poor appointment allocation policy can build long waiting times, even when capacity is sufficient to meet demand. By bringing waiting times down and going away from prioritisation, the waiting list size and average waiting times at the studied department could be maintained almost 90% below the current level - without requiring permanent change in the capacity/demand ratio.
| S-EPMC7093047 | biostudies-literature
Project description:BackgroundExcessive 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.MethodsWe 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.ResultsAcross 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.ConclusionsOur 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.
| S-EPMC7871621 | biostudies-literature
Project description:BackgroundLong 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.MethodsWe 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.ResultsThe 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.ConclusionsThe 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.
| S-EPMC7887721 | biostudies-literature
Project description:BackgroundA 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.MethodsData 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.FindingsA 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.ConclusionThe 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.
| S-EPMC8259989 | biostudies-literature
Project description:BackgroundConcern about long waiting times for elective surgeries is not a recent phenomenon, but it has been heightened by the impact of the COVID-19 pandemic and its associated measures. One way to alleviate the problem might be to use prioritisation methods for patients on the waiting list and a wide range of research is available on such methods. However, significant variations and inconsistencies have been reported in prioritisation protocols from various specialties, institutions, and health systems. To bridge the evidence gap in existing literature, this comprehensive systematic review will synthesise global evidence on policy strategies with a unique insight to patient prioritisation methods to reduce waiting times for elective surgeries. This will provide evidence that might help with the tremendous burden of surgical disease that is now apparent in many countries because of operations that were delayed or cancelled due to the COVID-19 pandemic and inform policy for sustainable healthcare management systems.MethodsWe searched PubMed, EMBASE, SCOPUS, Web of Science, and the Cochrane Library, with our most recent searches in January 2020. Articles published after 2013 on major elective surgery lists of adult patients were eligible, but cancer and cancer-related surgeries were excluded. Both randomised and non-randomised studies were eligible and the quality of studies was assessed with ROBINS-I and CASP tools. We registered the review in PROSPERO (CRD42019158455) and reported it in accordance with the PRISMA statement.ResultsThe electronic search in five bibliographic databases yielded 7543 records (PubMed, EMBASE, SCOPUS, Web of Science, and Cochrane) and 17 eligible articles were identified in the screening. There were four quasi-experimental studies, 11 observational studies and two systematic reviews. These demonstrated moderate to low risk of bias in their research methods. Three studies tested generic approaches using common prioritisation systems for all elective surgeries in common. The other studies assessed specific prioritisation approaches for re-ordering the waiting list for a particular surgical specialty.ConclusionsExplicit prioritisation tools with a standardised scoring system based on clear evidence-based criteria are likely to reduce waiting times and improve equitable access to health care. Multiple attributes need to be considered in defining a fair prioritisation system to overcome limitations with local variations and discriminations. Collating evidence from a diverse body of research provides a single framework to improve the quality and efficiency of elective surgical care provision in a variety of health settings. Universal prioritisation tools with vertical and horizontal equity would help with re-ordering patients on waiting lists for elective surgery and reduce waiting times.
| S-EPMC8404982 | biostudies-literature
Project description:This paper aims to analyse the variation in the delivery of diagnostic imaging services in order to suggest possible solutions for the reduction of waiting times, increase the quality of services and reduce financial costs. This study provides a logic model to manage waiting times in a regional context. Waiting times measured per day were compared on the basis of the variability in the use rates of CT and MRI examinations in Tuscany for the population, as well as on the basis of the capacity offered with respect to the number of radiologists available. The analysis was performed at the local health authority level to support the decision-making process of local managers. Diagnostic imaging services, in particular the CT and MRI examinations. The study involved all the 12 local health authorities that provide services for 3.7 million inhabitants of the Italian Tuscany Region. the study uses regional administrative data on outpatients and survey data on inpatient diagnostic examinations in order to measure productivity. The study uses the volumes per 1000 inhabitants, the days of waiting times and the number of examinations per radiologist. Variability was measured using the traditional SD measures. A significant variation in areas considered homogeneous in terms of age, gender or mortality may indicate that the use of radiological services is not optimal and underuse or overuse occurs and that there is room for improvement in the service organisation. Considering that there is a high level of variability among district use rates and waiting times, this study provides managers with a specific tool to find the cause of the problem, identify a possible solution, assess the financial impact and initiate the eventual reduction of waste.
| S-EPMC3533122 | biostudies-literature
Project description:BackgroundIn many universal health systems, waiting times act as a non-monetary rationing mechanism, one that should be based on clinical need rather than the ability to pay. However, there is growing evidence that among patients with similar levels of need, waiting times often differ according to socioeconomic status. The mechanisms underlying inequality in access remain unclear.MethodsUsing data for Spain, we study whether waiting times for primary and specialist care depend on patients' socioeconomic status (SES). Additionally, we make use of the continuous nature of our data to explore whether the SES-related differences in waiting times found for specialist consultations vary among different points of the waiting time distribution.ResultsOur results reveal the presence of a SES gradient in waiting times for specialist services explained on the basis of education, employment status and income. In addition, for primary care, we found evidence of a slightly more moderate SES gradient mostly based on employment status. Furthermore, although quantile regression estimates indicated the presence of a SES gradient within the distribution of waiting times for specialist visits, the SES differences attenuated in the context of longer waiting times in the public sector but did not disappear.ConclusionOur findings suggest the principle of equal treatment for equal need, assumed to be inherent to national health systems such as the Spanish system, is not applied in practice. Determining the mechanism(s) underlying this selective barrier to healthcare is of crucial importance for policymakers, especially in the current COVID-19 health and economic crises, which could exacerbate these inequalities as increasing numbers of treatments are having to be postponed.
| S-EPMC9763792 | biostudies-literature
Project description:IntroductionThe demand for adolescent mental health services has increased significantly in recent years, leading to excessive wait times for adolescents seeking mental health services and poor mental health outcomes. Timely access to mental health services is critical to reducing the risk of symptom chronicity and progression to mental disorder. A better understanding of whether and how interventions to reduce wait times impact mental health outcomes is needed to guide mental health policymakers and service planners in their approach to reducing wait times.Methods and analysisThe scoping review will use Arksey and O'Malley's six-stage framework for scoping reviews and Rayyan to support screening, data extraction and evidence synthesis. The review will be conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines. We will search the Cochrane Library, EBSCOhost, MEDLINE (Ovid), PsycArticles (Ovid), PsycINFO (Ovid), EMBASE (Ovid), Web of Science, ProQuest and Scopus databases for peer-reviewed texts published in English between 1 January 2000 and 28 February 2023. We will also search Google Scholar for additional grey literature. To be eligible for inclusion, studies must focus on adolescent populations aged 13-18 years and report on interventions to reduce wait times for any mental health service except crisis and emergency services. Title, abstract and full-text screening will be done by two reviewers. We will extract data describing the interventions and their effects on wait times and adolescent mental health outcomes, and we will identify strengths and limitations in the evidence base to inform recommendations for future research. A youth advisory group with lived experience of mental health difficulties will be consulted throughout the review process.Ethics and disseminationEthics approval is not required. Findings will be disseminated via peer-reviewed publications and presented at conferences.Study registrationThe protocol was registered with the Open Science Framework on 20 February 2023 (https://osf.io/qt4zy).
| S-EPMC10496663 | biostudies-literature