Prioritising waiting lists: how and why?

Mullen, Penelope

doi:10.1016/s0377-2217(02)00779-8

Cited by 46 publications

(33 citation statements)

References 27 publications

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“…Thus, benchmarks based on levels of urgency should ensure a more transparent and fair process of access to care. Various models have been proposed to implement prioritization systems and deal with issues such as the inclusion of time waiting to ensure that low-urgency cases receive treatment (Mullen 2003). Evaluation of these systems in practice is essential to assess the effects of implementation on access to care and patient outcomes.…”

Section: Discussionmentioning

confidence: 99%

Patient and Surgeon Views on Maximum Acceptable Waiting Times for Joint Replacement

Conner‐Spady

Johnston²,

Sanmartin³

et al. 2007

hcpol

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Objective: To assess patient and surgeon views on maximum acceptable waiting times (MAWT) for hip and knee replacement, their determinants and their relationship to levels of urgency based on the Western Canada Waiting List Priority Criteria Score (PCS). Methods: At the decision date for surgery, orthopaedic surgeons assessed consecutive patients with the PCS and MAWT. Patients were surveyed 3-12 months post-surgery for MAWT and potential determinants. Results: The patient sample of 208 was 56% female, mean age 69 years (SD 11). Mean MAWT for patients was 18 weeks (SD 11) and for surgeons, 17 weeks (SD 11). Median MAWT for three levels of urgency (PCS) ranged from 13-17 weeks (patients) and 9-26 weeks (surgeons). Patient MAWT was unrelated to the surgeonrated measures: MAWT (r=.05) and the PCS (r=-.10). Multiple regression analysis showed that males, knee vs. hip replacement, a longer waiting time and a perception of fairness in regard to waiting time were significant predictors of longer patient MAWT. Knee replacement, a better ability to walk without significant pain and less potential for progression of the disease were significant predictors of longer surgeon MAWT. Conclusions: Patient and surgeon perspectives on MAWT are important to the development of waiting time benchmarks. Benchmarks based on levels of urgency ensure a more transparent and fair process for waiting time management. Knowledge of determinants of MAWT should inform better management of waiting time and access, by understanding the basis of patient and physician views on acceptable waiting times. Méthodes : À la date de la décision, les chirurgiens orthopédiques ont évalué des patients consécutifs au moyen de la CCP et du TAMA. On a interrogé les patients entre 3 et 12 mois après la chirurgie relativement au TAMA et à ses facteurs détermi-nants potentiels. Résultats : L' échantillon de 208 patients était composé à 56 % de femmes dont la moyenne d' âge était de 69 ans (écart-type de 11). Chez les patients, le temps médian du TAMA était de 18 semaines (écart-type de 11) et chez les chirurgiens, de 17 semaines (écart-type de 11). Le temps médian du TAMA pour trois degrés d'urgence (CCP) allait de 13 à 17 semaines (patients) et de 9 à 26 semaines (chirurgiens). Chez les patients, le TAMA n' était pas lié aux mesures évaluées par les chirurgiens : TAMA (r = 0,05) et le CCP (r = -0,10). De multiples analyses de régression ont révélé que chez les hommes, pour l' arthroplastie du genou par rapport à la hanche, un temps d' attente plus long et un sentiment d' équité relativement au temps d' attente étaient des indices importants d'un TAMA plus long chez les patients. L' arthroplastie du genou, une meilleure capacité de marcher sans douleur importante et une moins grande possibilité de progression de la maladie étaient des indices importants du TAMA plus long chez les chirurgiens. Conclusions : Les points de vue des patients et des chirurgiens sur le TAMA sont importants pour l' établissement de temps d' attente de référence. La référence fond...

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Section: Discussionmentioning

confidence: 99%

Patient and Surgeon Views on Maximum Acceptable Waiting Times for Joint Replacement

Conner‐Spady

Johnston²,

Sanmartin³

et al. 2007

hcpol

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“…In the next step, patients are registered in prioritized elective waiting lists. Different prioritization algorithms can be used to arrange the waiting list and determine the sequence of activities for a surgical patient [35]. In the operative scenario under study, patient admissions are prioritized using a previously validated prioritization system, which is currently in use in the current operative scenarios [36,37].…”

Section: Discrete Event Simulation Modelmentioning

confidence: 99%

Improving the performance of surgery-based clinical pathways: a simulation-optimization approach

Özcan

Tànfani

Testi

2016

Health Care Manag Sci

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This paper aims to improve the performance of clinical processes using clinical pathways (CPs). The specific goal of this research is to develop a decision support tool, based on a simulation-optimization approach, which identify the proper adjustment and alignment of resources to achieve better performance for both the patients and the health-care facility. When multiple perspectives are present in a decision problem, critical issues arise and often require the balancing of goals. In our approach, meeting patients' clinical needs in a timely manner, and to avoid worsening of clinical conditions, we assess the level of appropriate resources. The simulation-optimization model seeks and evaluates alternative resource configurations aimed at balancing the two main objectives-meeting patient needs and optimal utilization of beds and operating rooms.Using primary data collected at a Department of Surgery of a public hospital located in Genoa, Italy. The simulation-optimization modelling approach in this study has been applied to evaluate the thyroid surgical treatment together with the other surgery-based CPs. The low rate of bed utilization and the long elective waiting lists of the specialty under study indicates that the wards were oversized while the operating room capacity was the bottleneck of the system. The model enables hospital managers determine which objective has to be given priority, as well as the corresponding opportunity costs.

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“…They are based on a wide variety of aspects often including medical urgency, professional priorities, resource use and time on the waiting list. Mullen [66] provides a comprehensive review of the priority scores developed over time including additive and multiplicative forms. The objective of the priority scores ranges from determining whether a patient is delayed or denied to defining the patient's urgency and importance.…”

Section: Categorization and Prioritizationmentioning

confidence: 99%

Trade-Offs in Operating Room Planning for Electives and Emergencies: A Review

Riet

Demeulemeester

2014

SSRN Journal

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The planning of the operating rooms (ORs) is a difficult process due to the different stakeholders involved. The real complexity, however, results from various sources of variability entering the processes. These uncertain processes cannot be ignored since they greatly influence the trade-offs between the hospital costs and the patient waiting times. As a result, a need for policies guiding the OR manager in handling the trade-offs arises. Therefore, researchers have investigated different possibilities to incorporate non-elective patients in the schedule with the goal of maximizing both patient-and hospital-related measures. This paper reviews the literature on OR planning where both elective and non-elective patient categories are involved. It shows the various policies, the differences and similarities in the research settings and the resulting outcomes, whether they are beneficial or not. We find that the dedicated and the flexible policy are mostly pursued, but the setting and the assumptions of the reviewed papers vary widely. Decisions on both operational policies as well as on capacity are required to assure timely access and efficiency, which are the two main drivers for the problem at hand. Furthermore, the policy choice impacts the number of schedule disruptions and the OR utilization. However, results on the overtime and the patient waiting time are partly contradicting. The review shows that some policies have already received considerable attention, but the question of which policies are most appropriate is not yet fully answered. Neither has the full spectrum of policies been explored yet. Consequently, this topic provides several areas for future research, which are outlined throughout the paper.

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Prioritising waiting lists: how and why?

Cited by 46 publications

References 27 publications

Patient and Surgeon Views on Maximum Acceptable Waiting Times for Joint Replacement

Patient and Surgeon Views on Maximum Acceptable Waiting Times for Joint Replacement

Improving the performance of surgery-based clinical pathways: a simulation-optimization approach

Trade-Offs in Operating Room Planning for Electives and Emergencies: A Review

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