The Effectiveness of Different Patient Referral Methods on Waiting Times for Adults Needing Elective Surgery - Systematic Review
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.
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Posted 28 Dec, 2020
Received 28 Dec, 2020
On 28 Dec, 2020
Received 14 Dec, 2020
On 07 Dec, 2020
On 25 Nov, 2020
Invitations sent on 23 Nov, 2020
On 22 Nov, 2020
On 22 Nov, 2020
On 22 Nov, 2020
Posted 21 Sep, 2020
On 26 Oct, 2020
Received 13 Oct, 2020
Received 13 Oct, 2020
On 28 Sep, 2020
On 28 Sep, 2020
Received 28 Sep, 2020
On 25 Sep, 2020
On 15 Sep, 2020
Invitations sent on 15 Sep, 2020
On 15 Sep, 2020
On 14 Sep, 2020
On 14 Sep, 2020
On 13 Aug, 2020
The Effectiveness of Different Patient Referral Methods on Waiting Times for Adults Needing Elective Surgery - Systematic Review
Posted 28 Dec, 2020
Received 28 Dec, 2020
On 28 Dec, 2020
Received 14 Dec, 2020
On 07 Dec, 2020
On 25 Nov, 2020
Invitations sent on 23 Nov, 2020
On 22 Nov, 2020
On 22 Nov, 2020
On 22 Nov, 2020
Posted 21 Sep, 2020
On 26 Oct, 2020
Received 13 Oct, 2020
Received 13 Oct, 2020
On 28 Sep, 2020
On 28 Sep, 2020
Received 28 Sep, 2020
On 25 Sep, 2020
On 15 Sep, 2020
Invitations sent on 15 Sep, 2020
On 15 Sep, 2020
On 14 Sep, 2020
On 14 Sep, 2020
On 13 Aug, 2020
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.
Figure 1
Figure 2
Figure 3