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Research article
The Effectiveness of Different Patient Referral Methods on Waiting Times for Adults Needing Elective Surgery - Systematic Review
Dimuthu Rathnayake
Queen's University Belfast Centre for Public Health
Corresponding Author
ORCiD: https://orcid.org/0000-0003-3919-6824
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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.
Keywords
referral methods, health systems, elective surgery, waiting time, waiting list, primary care practitioner, systematic review
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CURRENT STATUS: Under Review
Version (no preprint)
Posted 28 Dec, 2020
Review #2 received
Received 28 Dec, 2020
Editorial decision: Minor revision
On 28 Dec, 2020
Review #1 received
Received 14 Dec, 2020
Reviewer #2 agreed
On 07 Dec, 2020
Reviewer #1 agreed
On 25 Nov, 2020
Reviewers invited
Invitations sent on 23 Nov, 2020
Editor assigned
On 22 Nov, 2020
Submission checks complete
On 22 Nov, 2020
Editor invited
On 22 Nov, 2020
This version was not preprinted
Version 1
Posted 21 Sep, 2020
No community comments so far
Editorial decision: Major revision
On 26 Oct, 2020
Review #2 received
Received 13 Oct, 2020
Review #1 received
Received 13 Oct, 2020
Reviewer #3 agreed
On 28 Sep, 2020
Reviewer #4 agreed
On 28 Sep, 2020
Review #3 received
Received 28 Sep, 2020
Reviewer #2 agreed
On 25 Sep, 2020
Editor assigned
On 15 Sep, 2020
Reviewers invited
Invitations sent on 15 Sep, 2020
Reviewer #1 agreed
On 15 Sep, 2020
Submission checks complete
On 14 Sep, 2020
Editor invited
On 14 Sep, 2020
First submitted
On 13 Aug, 2020
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This preprint is under consideration at BMC Health Services Research. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
The Effectiveness of Different Patient Referral Methods on Waiting Times for Adults Needing Elective Surgery - Systematic Review
Dimuthu Rathnayake
Queen's University Belfast Centre for Public Health
Corresponding Author
ORCiD: https://orcid.org/0000-0003-3919-6824
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Under Review
Version (no preprint)
Posted 28 Dec, 2020
Review #2 received
Received 28 Dec, 2020
Editorial decision: Minor revision
On 28 Dec, 2020
Review #1 received
Received 14 Dec, 2020
Reviewer #2 agreed
On 07 Dec, 2020
Reviewer #1 agreed
On 25 Nov, 2020
Reviewers invited
Invitations sent on 23 Nov, 2020
Editor assigned
On 22 Nov, 2020
Submission checks complete
On 22 Nov, 2020
Editor invited
On 22 Nov, 2020
This version was not preprinted
Version 1
Posted 21 Sep, 2020
No community comments so far
Editorial decision: Major revision
On 26 Oct, 2020
Review #2 received
Received 13 Oct, 2020
Review #1 received
Received 13 Oct, 2020
Reviewer #3 agreed
On 28 Sep, 2020
Reviewer #4 agreed
On 28 Sep, 2020
Review #3 received
Received 28 Sep, 2020
Reviewer #2 agreed
On 25 Sep, 2020
Editor assigned
On 15 Sep, 2020
Reviewers invited
Invitations sent on 15 Sep, 2020
Reviewer #1 agreed
On 15 Sep, 2020
Submission checks complete
On 14 Sep, 2020
Editor invited
On 14 Sep, 2020
First submitted
On 13 Aug, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
License:
This work is licensed under a CC BY 4.0 License. Read Full License
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