1
|
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.
Collapse
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
| |
Collapse
|
2
|
Tsai PF, Lin FM. An Application of Multi-Attribute Value Theory to Patient-Bed Assignment in Hospital Admission Management: an Empirical Study. JOURNAL OF HEALTHCARE ENGINEERING 2014; 5:439-56. [DOI: 10.1260/2040-2295.5.4.439] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
3
|
Pomey MP, Forest PG, Sanmartin C, DeCoster C, Clavel N, Warren E, Drew M, Noseworthy T. Toward systematic reviews to understand the determinants of wait time management success to help decision-makers and managers better manage wait times. Implement Sci 2013; 8:61. [PMID: 23742217 PMCID: PMC3702455 DOI: 10.1186/1748-5908-8-61] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Accepted: 05/23/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Long waits for core specialized services have consistently been identified as a key barrier to access. Governments and organizations at all levels have responded with strategies for better wait list management. While these initiatives are promising, insufficient attention has been paid to factors influencing the implementation and sustainability of wait time management strategies (WTMS) implemented at the organizational level. METHODS A systematic review was conducted using the main electronic databases, such as CINAHL, MEDLINE, and Cochrane Database of Systematic Reviews, to identify articles published between 1990 and 2011 on WTMS for scheduled care implemented at the organizational level or higher and on frameworks for analyzing factors influencing their success. Data was extracted on governance, culture, resources, and tools. We organized a workshop with Canadian healthcare policy-makers and managers to compare our initial findings with their experience. RESULTS Our systematic review included 47 articles: 36 related to implementation and 11 to sustainability. From these, we identified a variety of WTMS initiated at the organizational level or higher, and within these, certain factors that were specific to either implementation or sustainability and others common to both. The main common factors influencing success at the contextual level were stakeholder engagement and strong funding, and at the organizational level, physician involvement, human resources capacity, and information management systems. Specific factors for successful implementation at the contextual level were consultation with front-line actors and common standards and guidelines, and at the organizational level, financial incentives and dedicated staffing. For sustainability, we found no new factors. The workshop participants identified the same major factors as found in the articles and added others, such as information sharing between physicians and managers. CONCLUSIONS Factors related to implementation were studied more than those related to sustainability. However, this finding was useful in developing a tool to help managers at the local level monitor the implementation of WTMS and highlighted the need for more research on specific factors for sustainability and to assess the unintended consequences of introducing WTMS in healthcare organizations.
Collapse
Affiliation(s)
- Marie-Pascale Pomey
- Department of Health Administration, Institut de Recherche en Santé Publique de l’Université de Montréal (IRSPUM), University of Montreal, 7101 Parc Avenue, Montreal, Quebec, H3N 1X7, Canada
| | - Pierre-Gerlier Forest
- Pierre Elliott Trudeau Foundation, 1514 Docteur-Penfield Avenue, Montreal, Quebec, H3G 1B9, Canada
| | - Claudia Sanmartin
- Health Analysis Division, Statistics Canada, 150 Tunney’s Pasture Driveway, Ottawa, Ontario, K1A 0T6, Canada
| | - Carolyn DeCoster
- Data Integration, Measurement & Reporting Service, Alberta Health Services, 10101 Southport Road SW, Calgary, Alberta, T2W 3N2, Canada
| | - Nathalie Clavel
- Department of Health Administration, Institut de Recherche en Santé Publique de l’Université de Montréal (IRSPUM), University of Montreal, 7101 Parc Avenue, Montreal, Quebec, H3N 1X7, Canada
| | - Elaine Warren
- Surgical Services, Eastern Health, Health Sciences Centre, Prince Philip Drive, St. John’s, Newfoundland, A1B 3V6, Canada
| | - Madeleine Drew
- Accreditation Canada, 1150 Cyrville Road, Ottawa, Ontario, K1J 7S9, Canada
| | - Tom Noseworthy
- Department of Community Health Sciences, University of Calgary, 2500 University Drive NW, Calgary, Alberta, T2N 1N4, Canada
| |
Collapse
|
4
|
Cromwell DA. Waiting time information services: An evaluation of how well clearance time statistics can forecast a patient's wait. Soc Sci Med 2004; 59:1937-48. [PMID: 15312927 DOI: 10.1016/j.socscimed.2004.02.027] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Governments in some countries have created web-based information services so that patients requiring elective surgery can compare the waiting times of surgical units. This study investigated how accurately the waiting times of patients about to join a waiting list can be forecast by various clearance time statistics. It used 3 years of elective surgical activity data that covered 46 surgeons in 10 specialties within a public hospital. Six clearance time functions were tested, and the best function was compared with average waiting time statistics derived from census and throughput data. The forecast accuracy of the clearance time functions was found to be greatly affected by the characteristics and behaviour of a surgeon's waiting list. Although there was less difference in performance among the six functions, systematic differences between them were also found. The best of these performed better than the statistics derived from waiting time data, especially where waiting times exceeded 6 months. Yet, its accuracy was still poor. For each surgeon with an average waiting time of more than 6 months, at least 20% of patients waited more than 90 days beyond the clearance time forecast. Consequently, while waiting time information services should consider adopting the clearance time approach, they need to be explicit about its statistical limitations.
Collapse
Affiliation(s)
- David A Cromwell
- Commission for Healthcare Audit and Inspection, Finsbury Tower, 103-105 Bunhill Row, London EC1Y 8TG, UK.
| |
Collapse
|
5
|
Foote JL, North NH, Houston DJ. Towards a systemic understanding of a hospital waiting list. J Health Organ Manag 2004; 18:140-54. [PMID: 15366280 DOI: 10.1108/14777260410548400] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Hospital waiting lists are a feature of publicly funded health services that result when demand appears to exceed supply. While much has been written about surgical waiting lists, little is known about the dynamics of radiology waiting lists, which is surprising given that rational treatment, and indeed the medical profession's claim to expertise, rests on establishing a diagnosis. This paper reports the findings of a case study of a problematic ultrasound waiting list. In particular, this paper highlights how the management of the ultrasound waiting list served to subordinate the needs of waiting patients and their general practitioners to the interests and values of radiologists. Radiologist concern to protect specialist expertise from encroachment by outpatient clinicians and sonographers is implicated in the growth of the ultrasound waiting list. It is argued that an adequate understanding of ultrasound waiting lists depends on grasping how radiologists are successful in structuring problems of access in ways that enhance radiologist control over ultrasound imaging. The case study reported helps to shed light on why increasing funding to clear waiting lists proves ineffective.
Collapse
Affiliation(s)
- J L Foote
- Institute of Environmental Science and Research Limited, Christchurch, New Zealand
| | | | | |
Collapse
|
6
|
Foote JL, Houston DJ, North NH. Betwixt and between: ritual and the management of an ultrasound waiting list. HEALTH CARE ANALYSIS 2003; 10:357-77. [PMID: 12814284 DOI: 10.1023/a:1023427210009] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Hospital waiting lists are a feature of publicly funded health services that results when demand appears to exceed supply. While much has been written about hospital waiting lists, little is known about the dynamics of diagnostic waiting lists, or more generally why hospital waiting lists behave in perverse and often counter-intuitive ways. This paper attempts to address this gap by applying a recent development in critical systems thinking called boundary critique to understand how a particular ultrasound waiting list was managed. A new waiting list metaphor based on waiting lists as ritual forms is proposed.
Collapse
Affiliation(s)
- J L Foote
- Institute of Environmental Science and Research Limited, College of Sciences, Massey University.
| | | | | |
Collapse
|
7
|
Vissers JM, Van Der Bij JD, Kusters RJ. Towards decision support for waiting lists: an operations management view. Health Care Manag Sci 2001; 4:133-42. [PMID: 11393742 DOI: 10.1023/a:1011409711828] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
This paper considers the phenomenon of waiting lists in a healthcare setting, which is characterised by limitations on the national expenditure, to explore the potentials of an operations management perspective. A reference framework for waiting list management is described, distinguishing different levels of planning in healthcare--national, regional, hospital and process--that each contributes to the existence of waiting lists through managerial decision making. In addition, different underlying mechanisms in demand and supply are distinguished, which together explain the development of waiting lists. It is our contention that within this framework a series of situation specific models should be designed to support communication and decision making. This is illustrated by the modelling of the demand for cataract treatment in a regional setting in the south-eastern part of the Netherlands. An input-output model was developed to support decisions regarding waiting lists. The model projects the demand for treatment at a regional level and makes it possible to evaluate waiting list impacts for different scenarios to meet this demand.
Collapse
Affiliation(s)
- J M Vissers
- Technische Universiteit Eindhoven, Department of Technology Management, The Netherlands.
| | | | | |
Collapse
|
8
|
Taylor K, Lane D. Simulation applied to health services: opportunities for applying the system dynamics approach. J Health Serv Res Policy 1998; 3:226-32. [PMID: 10187203 DOI: 10.1177/135581969800300409] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The aim of this essay is to raise awareness and broaden understanding within the health services community of the system dynamics (SD) simulation approach to policy analysis. The application of simulation in health services is reviewed. A comparison is made between the SD and traditional simulation approaches and is illustrated by considering reductions in waiting times for coronary heart disease treatment. Traditionally, simulation studies have tended to focus on the analysis of localized decisions and therefore on problems orientated towards individual patients. Although these methods are extremely powerful and effective, there is scope for an alternative modelling approach which is based on a more holistic perspective; SD is one such approach. It can assist in the design of robust policies by supporting debate on how the underlying structure might influence the evolutionary behaviour of a system. Using this method we can consider the time variation both of tangibles, such as waiting times and health care costs, and intangibles, such as patient anxiety and the effects of various pressures on purchasing decisions. We propose that SD holds great potential in assisting policy formation in health care.
Collapse
Affiliation(s)
- K Taylor
- Operational Research Department, London School of Economics and Political Science, London WC2A 2AE, UK
| | | |
Collapse
|
9
|
Abstract
Waiting lists are a common phenomenon in markets in which non-price allocation of goods and services occurs. To the extent that waiting lists for in-patient health services are perceived to ration imperfectly, many propose policies which focus on reducing demand or increasing supply. Strategies aimed at increasing supply often create perverse incentives in that they reward hospitals with long waiting lists through the provision of additional resources. This paper describes how supply has been addressed in Victoria by changing the financial incentives relating to waiting lists. The success of this payment policy in reducing waiting lists to public hospitals is reported.
Collapse
Affiliation(s)
- A Street
- York Health Economics Consortium, University of York, Heslington, UK
| | | |
Collapse
|