Candidate for the Lee B. Lusted Student Prize Competition
To provide comprehensive understanding of single-entry models’ ability to reduce wait times and their acceptability to patients and clinicians.
Method:
A two-step approach was adopted. 1) A detailed systematic literature synthesis involving nine medical, selected non-medical and multidisciplinary electronic bibliographic databases: we selected articles that reported computer simulation trials, before-after studies, descriptive studies and quasi-experimental studies of the use of single-entry models in the management of elective surgical procedures to address wait times and/or wait lists. Relevant studies were evaluated independently for inclusion eligibility by 2 individuals in a 2-stage process. 2) A patient questionnaire to explore patient perspectives towards pooled lists and single-entry approaches: questionnaires were administered to 114 patients from major Canadian cities - Calgary, Winnipeg, Toronto and Halifax - who were awaiting or had undergone hip and knee replacement. Questionnaires were pilot-tested and developed iteratively. The questions asked patients about surgeon preference and their acceptability of being seen by the first-available surgeon.
Result:
Review: Our search identified 1505 articles. Single-entry is commonly used in service industries, for example at banks, restaurants and airports, consolidating multiple queues into one. When used for surgery, single-entry models allow for wait lists to be pooled, services accessed through a single point-of-entry and for patients to see the first-available surgeon. Ten studies were considered from several countries and clinical disciplines. In general, they found that by shortening waiting times for patients awaiting surgery and increasing the number of patient referrals/patients seen, single-entry models can improve access to and the efficiency of patient care in both surgical and outpatient settings. Surgeons are generally opposed to pooling whereas most family physicians favour it.
Questionnaire: Patients consider trust, skill, reputation when selecting their surgeon; 81% valued choice. Patients were divided on seeing the first-available surgeon, even if it meant a reduction in waiting times. Patients would consider the first-available surgeon provided that he/she is equally qualified and that waiting times will decrease.
Conclusion:
Findings suggest that single-entry models are a promising waiting time management strategy and means of improving access, with generalizability to several choice-sensitive elective procedures. However, given that waiting time management strategies are often used in combination, reduced waiting times cannot solely be attributed to single-entry models. While favoured by some, acceptability of single-entry models isn’t universal.