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Impact of elective waiting times on acute demand for surgery.

Student: Whitney Gillies
Supervisors: Kay Poulsen, Suzanne Pitama
Sponsor: The Canterbury District Health Board

PROJECT DESCRIPTION:

Over the past 5 years the New Zealand elective services waiting lists have undergone a transformation into the booking system (a system by which patients received surgery by their priority rather then how long they have been waiting). This was done in an attempt to improve the appropriate prioritization of and fair access to elective surgery. Since the implementation of the Booking system the emergency department has seen a rise in the number of patients presenting as acute (seriously ill). This report attempts to establish if the patients being acutely admitted/ presenting to the Emergency Department (ED) were on the elective waiting list, having been placed in either active review (in which patients are reviewed every six months to see if their condition has deteriorated and they need surgery) or GP managed care (Patients that have been removed from the waiting list and been placed in the care of their GP).

HOW PROJECT WAS CARRIED OUT:

To determine whether this perception was accurate we needed to see if there was any relationship between the condition patients were being acutely admitted/presenting with at ED and the reason why they were on the waiting list. We did this by analysing data from General Surgery/ED. This data included waiting list patients being admitted acutely, as well as waiting list patients presenting at ED over the last two years (2002-2004). We also conducted a review of related literature to waiting list systems and a review of the changing trends over the last two years. To ensure our analysis of the data was as accurate as possible we engaged the services of a General Practitioner.

FINDINGS OF PROJECT:

After the data was analysed four key findings became evident.

1: There was a high proportion of patients presenting with conditions related to gallbladder (up to 27%).

2: There was a high percentage of patients being admitted as inpatients (up to 80%), yet only 52% of acutely admitted patients receive surgery.

3: The data collection methods of the emergency department were insufficient, mainly because of time pressures on staff and unspecific coding.

4: The number of wait list patients who presented at the Emergency Department and were then discharged to their GP has risen 17%. This is good as long as the patients receive adequate care after they have been discharged, otherwise they may present again.

RECOMMENDATIONS OF PROJECT:

In order that these results may be improved in future the following recommendations were made:

  •  Overall there is a need to put more resources into elective services for general surgery so that operations are performed within an appropriate time frame.
  • There is a need to allocate more resources to gallbladder related procedures.
  •  A review of the quality and capture of data in ED is necessary.
  •  There is a need to improve the method of assessment of surgical patients prior to admission.
  • Continue to progress the discharge of wait list patients to their GP (as long as they will receive adequate care).