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PubMed2002

Betwixt and between: ritual and the management of an ultrasound waiting list.

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.

Family Practice↗
PubMed1990

[Waiting lists and reality. Revision of the waiting list for reduction of breast hyperplasia in health region 1].

The Red Cross Hospital is the only public hospital providing plastic surgical services for the Oslo population. The waiting list for reduction mammaplasty had become unacceptably long. Some women had been waiting for as long as 4.5 years. We therefore decided to reexamine all the 309 patients in question. Only 22% were cleared for operation. 19% were removed temporarily from the waiting list due to obesity (awaiting weight reduction). The remainder was found to be either mainly motivated or to be motivated for mainly oesthetic reasons and therefore not eligible for public health funding.

Adult↗
PubMed2005

Where does the waiting list begin? A short review of the dynamics and organization of modern waiting lists.

Waiting for medical care is the by-product of system rationing, where demand exceeds supply. In this short report we expand on the conventional concept of the queue, by focusing on the regulation of demand and by incorporating a funnel and spout analogy. Real-world examples are used to illustrate the infancy of funnel or demand-side reform initiatives targeting the queue, and the suggestion is made that policy needs to address the concept of 'waiting' much earlier in the treatment cycle.

Catchment Area, Health↗
PubMed1996

Are waiting lists inevitable?

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.

Diagnosis-Related Groups↗
PubMed1995

[Waiting lists--how valid are the official numbers? Evaluation of a waiting list at a department of orthopedic surgery].

With increasing waiting lists for admission to hospital, the aim of this study was to investigate the reliability of an orthopaedic waiting list. Questionnaires were sent to every patient listed as waiting for more than three months. The questionnaire addressed the current symptoms and the current need for surgical treatment. In case of no reply, a further evaluation was done before eventual removal from the waiting list. Of 809 questionnaires mailed, replies were received from 409. A total of 376 were removed from the list, including 111 due to registration errors in the central data base. This study has shown how the indication for operation changes during the waiting period but also that information from data bases can be most unreliable. We find the reasons so general, that we recommend a corresponding evaluation of other waiting lists. Altogether, today's waiting list is faulty and thus provides a wrong basis for management.

Denmark↗
PubMed1987

Waiting list statistics. II: An estimate of inflation of waiting list length.

The discrepancy between the length of the waiting list and eventual admissions from the waiting list was investigated by comparing data from two different sources of routine statistics in the Oxford region. It was estimated that about 28% of the waiting list comprised patients who were not eventually admitted to hospital within the region.

Appointments and Schedules↗
PubMed2004

Waiting time in relation to wait-list size at registration: statistical analysis of a waiting-list registry.

OBJECTIVE: To examine the relationship between the length of a waiting list for elective vascular surgery and the delay before undergoing the operation. METHODS: We undertook a prospective cohort study of patients registered on the waiting list for elective vascular surgery at an acute care hospital in Ontario. Regression analysis of wait times to express the admission rate in one group relative to another, with the ratio of rates being a measure of the difference between groups. RESULTS: List length at registration was associated with length of wait (log-rank test 596.4, p < 0.0001). Patients who were registered when the list length exceeded the weekly service capacity had 70% lower conditional probability of undergoing surgery than those on a list with fewer patients (rate ratio 0.30, 95% confidence interval [CI] 0.26-0.36) after adjustment for sex, age, procedure and period. Registering more than 5 patients when the list was short had an independent effect (rate ratio 0.61, CI 0.45-0.82). CONCLUSIONS: The number of registrants on a surgical wait list has an effect on the length of delay in providing necessary treatment. Our results suggest that a regulated list-length policy may contribute to reducing waiting times. Hospital managers may also use the findings to reduce uncertainty in reporting expected waits given the current list size, thereby improving resource planning.

Cohort Studies↗
PubMed1997

[The waiting list guarantee. Variations in frequency of receiving the waiting list guarantee].

From 1987, patients waiting for treatment in Norwegian hospitals are given different degrees of priority, from zero to five. As from 1990, patients in priority group two are placed on a special list, and a report is made if they have not been treated within six months. There is a considerable variation in the frequency with which the patients are given this treatment guarantee in the different Norwegians counties. In the case of gynaecological patients the frequency varies from one to 94%, of urological patients from 43 to 100%, of orthopaedic patients from 21 to 89% and of otorhinolaryngological patients from 21 to 89%. The same variations are also seen within a single region of the country, and between departments. The reason for this discrepancy may be varying composition of the population, different extents of day surgery or different economic strategic thinking. Probably the main reason is that the criteria for giving a waiting list guarantee are not accepted as operational. This leads to different medical judgments when evaluating the applications for treatment in hospital.

Humans↗
PubMed2002

[Waiting list for nursing home admission gives limited insight of the problems. Study in handling of the waiting list and the consequences for the patients].

The waiting list for nursing home admission is expected to remain unacceptably long. A study of the use and of possibly problematic consequences of the waiting list was described in a thesis. Despite long mean waiting periods and many problems (depressive symptoms, experiences of burden) already at the start of the waiting period, the majority of the informal caregivers were satisfied with the waiting times. This may be explained by a reticence to nursing home admission and by enlistment to the waiting list "out of precaution". Both a long and a short waiting period could be experienced as too long. Waiting list figures give insufficient insight in the "real" demand for nursing home care and in problematic waiting periods.

Aged↗
PubMed2006

Prioritization of congenital cardiac surgical patients using fuzzy reasoning--a solution to the problem of the waiting list?

Surgical waiting lists are of high importance in countries, where the national health system is unable to deliver surgical services at a rate that would allow patients to avoid unnecessary periods of waiting. Prioritization of these lists, however, is frequently arbitrary and inconsistent. The objective of our research was to analyze the medical decision-making process when prioritizing patients with congenital cardiac malformations for cardiac surgical procedures, identifying an appropriate representation of knowledge, and transferring this knowledge onto the design and implementation of an expert system ("PrioHeart"). The medical decision-making process was stratified into three stages. The first was to analyze the details of the procedure and patient to define important impact factors on clinical priority, such as the risk of adverse events. The second step was to evaluate these impact factors to define an appropriate "timing category" within which a procedure should be performed. The third, and final, step was to re-evaluate the characteristics of individual patients to differentiate between those in the same timing category. We implemented this decision-making process using a rule-based production system with support for fuzzy sets, using the FuzzyCLIPS inference engine and expert system shell as a suitable development environment for the knowledge base. The "PrioHeart" expert system was developed to give paediatric cardiologists a tool to allow and facilitate the prioritization of patients on the cardiosurgical waiting list. Evaluation of "PrioHeart" on limited sets of patients documented appropriate results of prioritization, with a significant correlation between the prioritization made using "PrioHeart" and those results obtained by the individual consultant specialist. We conclude that our study has demonstrated the feasibility of using an expert system approach with a fuzzy, rule-based production system to implement the prioritization of cardiac surgical patients. The approach may potentially be transferable to other medical subspecialities.

Cardiac Surgical Procedures↗
PubMed2005

The prioritization of patients on waiting lists for cataract surgery: validation of the Western Canada waiting list project cataract priority criteria tool.

PURPOSE: To assess the validity of the Cataract Priority Criteria Score (PCS), developed by the Western Canada Waiting List (WCWL) Project to determine patient prioritization for cataract surgery. METHODS: Ophthalmologists assessed consecutive patients with the PCS and a visual analogue scale of urgency (VAS Urgency). Patients were mailed questionnaires pre- and post-surgery. Outcome measures were the Visual Function Assessment (VFA), EuroQol (EQ-5D), and best-corrected visual acuity. RESULTS: The sample of 253 patients was 58% female (mean age, 73.7 years); 166 completed pre-and post-surgery VFA. The correlation of the PCS and VAS Urgency was 0.65 (p = 0.000). Adjusting for age, first or second eye surgery, and post-operative complication, the PCS predicted improvement in the VFA and visual acuity (p < .05). CONCLUSIONS: These data provide some evidence to support the convergent and predictive validity of the PCS. Multiple patient outcomes should be used in the evaluation of the validity of priority scores.

Aged↗
PubMed2006

Managing the kidney waiting list.

Candidates on the kidney transplant list wait for longer periods and have increasing numbers of comorbid conditions. To ensure that these candidates are acceptable for transplantation when an organ becomes available, physical, psychosocial, and financial strategies are essential. The authors surveyed 68 transplant centers to determine current practices. Eighteen percent of centers did not reevaluate candidates. Other programs used time on the list, disease, age, or a combination of these factors as evaluation criteria. Initial cardiac evaluation was relied upon by 51.4% of centers, with varying criteria used to determine status. Social work evaluation was done by 42.6% of centers, usually annually. Annual financial reevaluation was performed in 57.4%. Data support reviewing candidates, especially those with diabetes, those who have been receiving dialysis for a long time, and those older than 60 years. The dedication of one coordinator to manage waitlisted candidates using age, diagnosis, and time receiving dialysis was effective in this study.

Aftercare↗
PubMed2000

Setting priorities for waiting lists: defining our terms. Steering Committee of the Western Canada Waiting List Project.

In order to develop standardized measures to assess patients' relative priority for services for which there are waiting lists, it is essential that key terms be clearly defined. We propose that severity be defined as the degree or extent of suffering, limits to activities or risk of death; that urgency be defined as severity combined with considerations of the expected benefit and the natural history of the condition; that need be considered equivalent to urgency; and that priority be defined in terms of urgency (or need) with or without consideration of social factors.

Disease Progression↗
PubMed2001

[Health status of patients on waiting lists].

BACKGROUND: The waiting lists for hospital admission are used as arguments for more resources to hospitals. Concern is expressed that the attention given to waiting list patients has the effect that less resources are devoted to other groups of patients. This article reports on a study of whether waiting list patients are in poorer health that persons who are not on a waiting list. MATERIAL AND METHODS: A random sample of 5,000 Norwegian citizens were drawn to be included in Statistics Norway's 1998 quality and standard of life survey. Interviews were obtained with 3,449 persons. Binomial and multinomial logistic analyses were used. RESULTS: Individuals in poor health have a higher probability of being on a hospital waiting list than have persons in good health. We did not find any relationship between state of health and a patient's experienced waiting time. INTERPRETATION: Our findings reject the assertion of arbitrariness regarding the selection of patients to hospital waiting lists. The lack of effect of state of health on experienced waiting time could be interpreted in several ways.

Adult↗
PubMedDate not supplied

[HCV+ patients on the waiting list for kidney transplantation. Retrospective analysis of data on the patient population with hepatitis C on the waiting list for kidney transplantation in the setting of the AIRT].

BACKGROUND: HCV infection in hemodialysis is still a matter of debate from an epidemiological and clinical point of view. Evaluation criteria for HCV-infected patients as transplant candidates are still not adequately standardized. Aims of the present study were to investigate: 1. the percentage of HCV positive patients on the waiting list of three Italian regions belonging to the Associazione InterRegionale Trapianti (AIRT); 2. to analyze the clinical approach in the evaluation of these patients in the attempt to define national guidelines for their pre- and post-transplant management. PATIENTS: We evaluated 2045 uremic patients on the waiting lists of four transplant centers (Bari, Bologna, Modena, Novara) belonging to AIRT at 31/12/2002. RESULTS: The overall prevalence of HCV positive patients was 14.2%, with a peak in the Puglia waiting list. The most common screening tests were AST and ALT serum levels and viral load (HCV RNA). Although there is a clear evidence that histological parameters are the main diagnostic and prognostic markers, a liver biopsy was performed in only 9.5% of patients. An even smaller percentage of HCV-infected patients underwent anti-viral therapy. CONCLUSIONS: Our retrospective analysis evidenced the need to improve common clinical strategies in approaching HCV-infected canditates to renal transplantation in the attempt to improve their post-transplant outcome.

Adult↗