IMPLEMENTATION OF A CENTRALIZED WAIT LIST MANAGEMENT SYSTEM FOR ELECTIVE ORTHOPAEDIC SURGERIES.

Abstract

A centralized wait list management system (WLMS) for TKR, THR and knee arthroscopy was developed to collect accurate data on parameters of patients’ wait for surgery. A priority metric rating patient priority was implemented. Data from hospital enterprise systems related to aspects of patients’ wait for surgery was collected and imported. Patients’ functional status was significantly worse than population norms, they were adversely affected while waiting and are unsatisfied with their access to surgery. Traffic ratios (ratio of booked to completed surgeries) exceed the maximum value for a stable wait list and the waits for surgery exceed national and international recommendations for maximum wait-times.

To develop and implement a WLMS for TKR, THR and knee arthroscopy to enable the accurate and efficient collection of data on size of list, rate of list growth, rate surgeries are performed, health and functional status of patients, and surgeon rated priority.

Patients are adversely affected while waiting and are unsatisfied with the length of their wait. Traffic ratios exceed the maximum value for a stable waitlist. The priority metric has face validity for rating patient acuity.

SF36 and WOMAC scores were three to four standard deviations worse than the population norm, over 50% of patients felt wait time would negatively affect outcome, 80% felt waits should be twelve months or less, and over 50% were unsatisfied with access to surgery. VAS scores were normally distributed with good face validity. Wait times are one hundred and thirty to three hundred days for arthroplasty and ninety to four hundred days for arthroscopy. Traffic ratios are 0.9 for arthroplasty and 1.5 for arthroscopy.

Prospective outcomes with respect to the wait list will allow determination of minimum acceptable wait times from administrative, surgeon and patient perspectives. Accurate and reliable collection of wait list data provides a sound basis for future decision-making.

Surgery bookings were centralized. A priority metric based on a visual analog scale (VAS) with a single question asking the surgeon to rate the patient priority was implemented. A cross-sectional postal survey was conducted. Data from hospital enterprise systems related to aspects of patients’ wait for surgery was collected and imported into the WLMS.