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A model to prioritize access to elective surgery on the basis of clinical urgency and waiting time.

Valente R, Testi A, Tanfani E, Fato M, Porro I, Santo M, Santori G, Torre G, Ansaldo G - BMC Health Serv Res (2009)

Bottom Line: This is true although since 2002 the National Government has defined implicit Urgency-Related Groups (URGs) associated with Maximum Time Before Treatment (MTBT), similar to the Australian classification.It allows homogeneous and standardized prioritization, enhancing transparency, efficiency and equity.Due to its applicability, it might represent a pragmatic approach towards surgical waiting lists, useful in both clinical practice and strategic resource management.

View Article: PubMed Central - HTML - PubMed

Affiliation: Health Management Unit, S. Martino University Hospital, L.go R. Benzi 10, 16132 Genoa, Italy. roberto.valente@gmail.com

ABSTRACT

Background: Prioritization of waiting lists for elective surgery represents a major issue in public systems in view of the fact that patients often suffer from consequences of long waiting times. In addition, administrative and standardized data on waiting lists are generally lacking in Italy, where no detailed national reports are available. This is true although since 2002 the National Government has defined implicit Urgency-Related Groups (URGs) associated with Maximum Time Before Treatment (MTBT), similar to the Australian classification. The aim of this paper is to propose a model to manage waiting lists and prioritize admissions to elective surgery.

Methods: In 2001, the Italian Ministry of Health funded the Surgical Waiting List Info System (SWALIS) project, with the aim of experimenting solutions for managing elective surgery waiting lists. The project was split into two phases. In the first project phase, ten surgical units in the largest hospital of the Liguria Region were involved in the design of a pre-admission process model. The model was embedded in a Web based software, adopting Italian URGs with minor modifications. The SWALIS pre-admission process was based on the following steps: 1) urgency assessment into URGs; 2) correspondent assignment of a pre-set MTBT; 3) real time prioritization of every referral on the list, according to urgency and waiting time. In the second project phase a prospective descriptive study was performed, when a single general surgery unit was selected as the deployment and test bed, managing all registrations from March 2004 to March 2007 (1809 ordinary and 597 day cases). From August 2005, once the SWALIS model had been modified, waiting lists were monitored and analyzed, measuring the impact of the model by a set of performance indexes (average waiting time, length of the waiting list) and Appropriate Performance Index (API).

Results: The SWALIS pre-admission model was used for all registrations in the test period, fully covering the case mix of the patients referred to surgery. The software produced real time data and advanced parameters, providing patients and users useful tools to manage waiting lists and to schedule hospital admissions with ease and efficiency. The model protected patients from horizontal and vertical inequities, while positive changes in API were observed in the latest period, meaning that more patients were treated within their MTBT.

Conclusion: The SWALIS model achieves the purpose of providing useful data to monitor waiting lists appropriately. It allows homogeneous and standardized prioritization, enhancing transparency, efficiency and equity. Due to its applicability, it might represent a pragmatic approach towards surgical waiting lists, useful in both clinical practice and strategic resource management.

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Related in: MedlinePlus

SWALIS application: waiting list screenshot. Screen capture of SWALIS system. Software environment was built with a main waiting list display, showing all registrations together with pre-admission summary information in a single recordset ordered by descending priority score.
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Figure 1: SWALIS application: waiting list screenshot. Screen capture of SWALIS system. Software environment was built with a main waiting list display, showing all registrations together with pre-admission summary information in a single recordset ordered by descending priority score.

Mentions: A system prototype was developed by using open source technologies [23]. The software ordered all registrations in a single priority-sorted list in real time and suggested admissions for patients with the highest priority score, including a short term waiting list forecast (one to four weeks). Priority was displayed to users as a percentage of the MTBT of each patient in the list, so that nurses and doctors had a complete picture in a single screenshot without further operation (Figure 1).


A model to prioritize access to elective surgery on the basis of clinical urgency and waiting time.

Valente R, Testi A, Tanfani E, Fato M, Porro I, Santo M, Santori G, Torre G, Ansaldo G - BMC Health Serv Res (2009)

SWALIS application: waiting list screenshot. Screen capture of SWALIS system. Software environment was built with a main waiting list display, showing all registrations together with pre-admission summary information in a single recordset ordered by descending priority score.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2651867&req=5

Figure 1: SWALIS application: waiting list screenshot. Screen capture of SWALIS system. Software environment was built with a main waiting list display, showing all registrations together with pre-admission summary information in a single recordset ordered by descending priority score.
Mentions: A system prototype was developed by using open source technologies [23]. The software ordered all registrations in a single priority-sorted list in real time and suggested admissions for patients with the highest priority score, including a short term waiting list forecast (one to four weeks). Priority was displayed to users as a percentage of the MTBT of each patient in the list, so that nurses and doctors had a complete picture in a single screenshot without further operation (Figure 1).

Bottom Line: This is true although since 2002 the National Government has defined implicit Urgency-Related Groups (URGs) associated with Maximum Time Before Treatment (MTBT), similar to the Australian classification.It allows homogeneous and standardized prioritization, enhancing transparency, efficiency and equity.Due to its applicability, it might represent a pragmatic approach towards surgical waiting lists, useful in both clinical practice and strategic resource management.

View Article: PubMed Central - HTML - PubMed

Affiliation: Health Management Unit, S. Martino University Hospital, L.go R. Benzi 10, 16132 Genoa, Italy. roberto.valente@gmail.com

ABSTRACT

Background: Prioritization of waiting lists for elective surgery represents a major issue in public systems in view of the fact that patients often suffer from consequences of long waiting times. In addition, administrative and standardized data on waiting lists are generally lacking in Italy, where no detailed national reports are available. This is true although since 2002 the National Government has defined implicit Urgency-Related Groups (URGs) associated with Maximum Time Before Treatment (MTBT), similar to the Australian classification. The aim of this paper is to propose a model to manage waiting lists and prioritize admissions to elective surgery.

Methods: In 2001, the Italian Ministry of Health funded the Surgical Waiting List Info System (SWALIS) project, with the aim of experimenting solutions for managing elective surgery waiting lists. The project was split into two phases. In the first project phase, ten surgical units in the largest hospital of the Liguria Region were involved in the design of a pre-admission process model. The model was embedded in a Web based software, adopting Italian URGs with minor modifications. The SWALIS pre-admission process was based on the following steps: 1) urgency assessment into URGs; 2) correspondent assignment of a pre-set MTBT; 3) real time prioritization of every referral on the list, according to urgency and waiting time. In the second project phase a prospective descriptive study was performed, when a single general surgery unit was selected as the deployment and test bed, managing all registrations from March 2004 to March 2007 (1809 ordinary and 597 day cases). From August 2005, once the SWALIS model had been modified, waiting lists were monitored and analyzed, measuring the impact of the model by a set of performance indexes (average waiting time, length of the waiting list) and Appropriate Performance Index (API).

Results: The SWALIS pre-admission model was used for all registrations in the test period, fully covering the case mix of the patients referred to surgery. The software produced real time data and advanced parameters, providing patients and users useful tools to manage waiting lists and to schedule hospital admissions with ease and efficiency. The model protected patients from horizontal and vertical inequities, while positive changes in API were observed in the latest period, meaning that more patients were treated within their MTBT.

Conclusion: The SWALIS model achieves the purpose of providing useful data to monitor waiting lists appropriately. It allows homogeneous and standardized prioritization, enhancing transparency, efficiency and equity. Due to its applicability, it might represent a pragmatic approach towards surgical waiting lists, useful in both clinical practice and strategic resource management.

Show MeSH
Related in: MedlinePlus