The Effectiveness of Different Patient Referral Methods on Waiting Times for Adults Needing Elective Surgery - Systematic Review

Abstract

Background: Long waiting times and lengthy queues for elective surgery are common to many publicly funded health systems. Primary care practitioners play a major role in determining which patients are referred to the consultant surgeon and might represent an opportunity to improve this situation. With conventional methods of referrals, surgery clinics are often overcrowded with non-surgical referrals and surgical patients experience longer waiting times as a consequence. Improving the quality of referral communications should lead to more timely access and better cost-effectiveness for elective surgical care. This review summarises the research evidence for interventions within the scope of primary care referral methods in the surgical care pathway that might shorten waiting time for elective surgeries.Methods: We searched PubMed, EMBASE, SCOPUS, Web of Science and Cochrane Library databases in December 2019 to January 2020, for articles published after 2013. Eligibility criteria included major elective surgery lists of adult patients, excluding cancer and cancer related surgeries. Randomised trials and non-randomised controlled studies were eligible. The main outcome variable of interest was waiting time for the elective surgery. The quality of evidence was assessed using ROBINS-I, AMSTAR 2 and CASP, as appropriate to the study method used. The review presentation was limited to a narrative synthesis because of heterogeneity. The PROSPERO registration number is CRD42019158455.Results: The electronic search yielded 7543 records. Finally, nine articles were considered as eligible after deduplication and full article screening. The eligible research varied widely in design, scope, reported outcomes and overall quality, with one randomised trial, two quasi-experimental studies, two longitudinal follow up studies, three systematic reviews and one observational study. The included research showed that patient triage and prioritisation at the referral stage improved timely access and increased the number of consultations of surgical patients in clinics.Conclusions: The available studies included a variety of interventions and were of medium to high quality, showing that methods to improve the management of primary care referrals of patients for elective surgery can reduce waiting times and shorten waiting lists for elective surgery for adults.

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

“…Unacceptable variability among waiting times in the same specialty in different surgeons or centres and variability in waiting times among different specialties need to be balanced to achieve horizontal and vertical equity for access to health care [ 49 ]. Adapting prioritisation principles at earlier stages, when the patients were referred to surgical clinics has also been shown to be effective in providing timely services [ 55 ]. This information might help healthcare managers and policy makers to enhance the local applicability of the implemented prioritisation tools and methods.…”

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

“…Unacceptable variability among waiting times in the same specialty in different surgeons or centres and variability in waiting times among different specialties need to be balanced to achieve horizontal and vertical equity for access to health care (44). Adapting prioritisation principles at earlier stages, when the patients were referred to surgical clinics has also been shown to be effective in providing timely services (54). This information might help healthcare managers and policy makers to enhance the local applicability of the implemented prioritisation tools and methods.…”