Patient prioritisation methods to shorten waiting times for elective surgery: a systematic review of how to improve access to surgery

Abstract

Background: Concern 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. Methods: We 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. Results: The 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 a 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. Conclusions: Explicit 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. Keywords: Patient prioritisation, elective surgery, waiting time, systematic review

Application of fuzzy TOPSIS for prioritization of patients on elective surgeries waiting list - A novel multi-criteria decision-making approach

“…Average wait-time is a key measure to gauge the performance of prioritization of waitlist (Rahimi et al, 2017;Rana et al, 2022;Rathnayake et al, 2021;Silva-Aravena et al, 2021). It can be seen that MCDM techniques reduce the average waiting time and as compared to WSM, Fuzzy TOPSIS technique (proposed in this research) has not only reduced it further but also substantially reduce maximum wait-time and number of delayed surgeries.…”

“…Patients' prioritization is a process of ranking patients based on the important or significant factors (Déry et al, 2020;Rathnayake et al, 2021). After referral, a specialist examines and evaluates the patients' health condition and decides the priority to perform the relevant procedure.…”

Efficient perioperative time-management methods for operating theatres: a systematic review showing how to reduce overall patient waiting times for elective surgery

“…This review assesses the effects of perioperative time-management methods on waiting times of patients for elective surgeries as one of the sub-reviews in a portfolio of systematic reviews conducted with a broader search to support a holistic approach to nding solutions for long waiting times for elective surgery (19,20). The portfolio review was registered in PROSPERO (CRD42019158455) and the review is reported here according to the PRISMA 2009 statement and checklist (21).…”

Monitoring Enjoyment of the Rights to Adequate Housing and Health Care and Protection in Aotearoa New Zealand

“…It is vital that healthcare systems appropriately prioritise surgeries to reduce the impact of health complications from long surgery waiting times (Rathnayake, Clarke, & Jayasinghe, 2021).…”