The active management of surgical waiting lists: a urological surgery case study

Abstract

Elective surgery waiting list management is a major public healthcare issue. This case study describes an integrated multifaceted approach to waiting list management at Peninsula Health, a public health service in Victoria, Australia. At the commencement of this study it was recognised that several issues associated with the urological surgical service constituted potential clinical risk. These included: recall mechanisms for multiple surveillance procedures; significant resource deficits; and long surgery waiting times. Responding to these issues a multifaceted approach to wait list management was implemented including: audit; direct lines of communication between clinical and administrative staff; urgent caseload management; utilisation of the Elective Surgery Access Scheme; financial and resource analysis justifying the appointment of a full-time urologist, and the establishment of a urology service from a satellite campus; implementation of a recall database; development of an outpatient service; and commencement of a day surgery initiative. This approach yielded results that included a 67% reduction in the number of ‘ready for care’ patients and a 78% reduction in the number of patients classified as ‘overdue for surgery’. Average wait time for semi-urgent and non-urgent patients reduced from 248 days to 180 days in the 10-month period.

What is known about the topic? Currently there are ~3000 people on the elective surgery waiting list in Victoria. Reasons for delays are multifactorial including shortage of beds, lack of surgeons, theatres and equipment. Patients are placed on the surgery waiting list according to a clinical urgency category assigned by their specialist. These categories are used by the hospitals to ensure that the patients with the greatest need are treated in the shortest period of time. Despite this, the numbers on the elective waiting lists within certain surgical specialities continue to grow and the numbers seen within the recommended time decreases.

What does this paper add? This paper outlines a management strategy for the urology wait list at a large Victorian hospital. It outlines six approaches, the implementation of which had a measurable positive effect on the waiting list numbers.

What are the implications for practitioners? The strategies put into place have been sustainable and continue to ensure that the urology waiting list is well managed.