Introducing a reserve waiting list initiative for elective general surgery at a District General Hospital

Patient waiting time analysis for elective gynecologic surgeries in a tertiary training hospital in the Philippines: A retrospective cross-sectional study

Objectives

This study aimed to determine the median waiting time and assess the factors affecting patient waiting time and scheduling for elective gynecologic surgery in a tertiary training hospital in the Philippines.

Methods

A retrospective analysis of waiting times for elective gynecologic surgeries was performed. The different time intervals for each step of the process map were determined. Regression models were used to study the relationship between waiting time intervals and demographic data, consideration of malignancy, and surgeries performed.

Results

The median waiting time from the date of the first consult to surgery was 154 days. Patients with consideration of malignancy and pelvic organ prolapse had significantly longer intervals from the Waitlist Clinic to actual surgery with regression coefficients of 6.76 and 17.53 days, respectively. Other intervals in the process map did not show significant differences.

Conclusions

The median waiting time for elective gynecologic surgeries in a tertiary training institution in the Philippines was longer than global standards. A significant amount of time was spent waiting for diagnostic studies and referral to the Waitlist Clinic. The study recommends regulating and improving systems processes at the hospital and national levels to decrease patient waiting time. Surgical waitlists, referral systems, and benchmarks for safe waiting times should be established.

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The median waiting time for elective gynecologic surgeries in a tertiary training institution in the Philippines was found to be longer than global standards.

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At the hospital level, strategies to decrease the waiting time should involve logistical analysis and changes in the physical setup, human resources, and process flows.

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Referral systems to other hospitals capable of providing care for less specialized surgeries should be explored. Interventions should improve coordination between providers to enhance the quality of care and avoid unnecessary delays in healthcare delivery.

Pediatric Plastic Surgery Operating Room Block-Time Utilization: A Casualty of Illness

BACKGROUND

Optimizing operating room (OR) utilization is a critical component of health care system efficiency. The purpose of our study was to analyze the extent of OR cancellation and its effect on raw utilization of OR block time allotted to surgeons in the pediatric plastic surgery department.

METHODS

The authors retrospectively reviewed the cases of 4 plastic surgeons at a tertiary pediatric hospital between 2018 and 2019. Data collected included patient demographics, type of surgery, time of cancellation, reason for cancellation, length of surgery, and minutes of block time allotted to each surgeon per year. Percent of cases canceled, scheduled times lost, and block times lost were calculated.

RESULTS

Surgeons A, B, C, and D scheduled 170, 416, 305, and 474 cases, respectively. Overall, 7% of cases were canceled, 9.1% of scheduled time was lost, and a total of 5.1% of block time was lost due to cancellation. Patients of surgeon A and D were more likely to cancel due to reasons classified as "other," including causes such as failure of nil per os or a family's last-minute decision to forego elective surgery (33.3% and 37.2%, respectively), whereas patients of surgeon B and C were more likely to cancel due to illness (67.9% and 36.4%, respectively).

CONCLUSIONS

Cancellations negatively impact raw utilization times; if fewer cases are performed, allotted block times are redistributed. Communication with patients in the week prior to surgery may allow for earlier identification of likely cancellations. Future directions include exploring whether particular surgeon characteristics are linked to rate of cancellations.