Reducing the wait for surgical consultation—what works and what doesn’t?—a review of selected countries in North America, Europe and Australasia

Abstract

Wait times for elective health services have been a policy challenge in health systems of most developed nations. Many countries have attempted to reduce wait times for surgery (including the wait to a surgical consultation and for surgery itself) by implementing innovative policies under limited resources.The purpose of this study was to present and discuss approaches implemented in several countries targeting wait times from referral to first appointment with a surgeon (wait time 1). This was part of a health evidence review to identify approaches used to reduce elective surgical wait times. Two sources of information, interviews and a scoping review were conducted to identify approaches targeting wait time 1.Interview participants were identified through several sources. Interview questions were semi-structured and open-ended, and responses were validated through participants being invited to review the accuracy and completeness of the information they provided. Interview data were analyzed by 2 researchers using deductive and inductive 'coding'. Search strategies for the scoping review were applied in multiple scientific databases, government, and health delivery organizations' webpages. Approaches identified through various sources were combined using a conceptual framework based on the main types of policy for improving wait times. A total of 19 interviews, 92 peer-reviewed articles, and 124 documents from the grey literature were included. Information spanned 13 countries and multiple specialities. Among 24 approaches identified, 18 targeted increasing supply, two aimed at reducing demand, and four impacted both supply and demand.12 of them provided consistent positive or limited but promising evidence of effectiveness on wait time 1.Approaches reduced wait times by affecting the supply, demand, or both sides. Many had evidence relating to their effectiveness in improving wait times and other patient and provider-related outcomes. The 9 approaches with consistent evidence of effectiveness were: Central intake, Expanded role for non-physicians, Patient choice, Standardized referral forms, Specialist advice requests, Expanded role for family doctors, Process improvement methodology, Remote consultations, and Fast track programs.

Delivery and Prioritization of Surgical Care in Canada During COVID-19: An Environmental Scan

“…However, the objective and desired outcomes of policies are different beyond COVID-19; to increase surgical capacity rather than decrease it. Some evidence-based strategies for reducing surgery wait times include outsourcing publicly funded surgeries to private surgical facilities, 23,37,40 central referral and waitlist management systems, 23,41,42 implementing surgical pathways, [43][44][45] and creating a larger role for family physicians and allied healthcare providers. 23,40,46,47 While these strategies have some evidence to support their effectiveness, 21,23,40,41,[43][44][45][46][47][48][49][50] the available evidence is sparse and of lower quality.…”

“…Some evidence-based strategies for reducing surgery wait times include outsourcing publicly funded surgeries to private surgical facilities, 23,37,40 central referral and waitlist management systems, 23,41,42 implementing surgical pathways, [43][44][45] and creating a larger role for family physicians and allied healthcare providers. 23,40,46,47 While these strategies have some evidence to support their effectiveness, 21,23,40,41,[43][44][45][46][47][48][49][50] the available evidence is sparse and of lower quality. Policymakers had little evidence to support the development of policies enacted during COVID-19 due to the rapidly evolving nature of COVID-19.…”