Abstract
BackgroundLong waiting times for elective surgery are common to many publicly funded health systems. Inefficiencies in referral systems in high-income countries are more pronounced than lower and middle-income countries. Primary care practitioners play a major role in determining which patients are referred to 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 effective interventions within the scope of primary-care referral methods in the surgical care pathway that might shorten waiting time for elective surgeries.MethodsWe 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 related surgeries. Both randomised and non-randomised controlled studies were eligible. 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.ResultsThe 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. All the six original articles were based on referral methods in high-income countries. 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.ConclusionsThe available studies included a variety of interventions and were of medium to high quality researches. Managing patient referrals with proper triaging and prioritisation using structured referral formats is likely to be effective in health systems to shorten the waiting times for elective surgeries, specifically in high-income countries.
Highlights
Long waiting times for elective surgery are common to many publicly funded health systems
At the final stage of inclusion, we focused on studies pertaining to the management of referral systems with an intention to reduce long waiting times for elective surgery
After grouping the citations into different strategies, three systematic reviews and six original studies were included for the final analysis of this sub-review, given their focus on interventions relevant to managing patient referrals as a way to reduce waiting time for elective surgery
Summary
Long waiting times for elective surgery are common to many publicly funded health systems. This review summarises the research evidence for effective interventions within the scope of primary-care referral methods in the surgical care pathway that might shorten waiting time for elective surgeries. Demand for surgery is growing and has exceeded the capacity of hospital services [2], leading to long waiting times and lengthy queues in many publicly funded health systems [3,4,5,6]. Lengthy waiting lists cause distress to the patients who are waiting and to service providers This has led to waiting times for elective surgeries becoming a major policy concern in many countries, especially those with health systems operated with public funds [7, 8]
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