Audit of prioritisation for coronary revascularisation procedures: implications for rationing

Area of Science:

• Cardiology
• Health Services Research

Background:

• Coronary revascularisation is a critical intervention for patients with severe coronary artery disease.
• Timely access to procedures like coronary artery bypass surgery (CABG) and percutaneous transluminal angioplasty (PTCA) is essential for optimal patient outcomes.
• Current waiting list management may not adequately reflect patient urgency based on clinical factors.

Purpose of the Study:

• To audit the prioritization of patients awaiting coronary revascularisation.
• To compare actual waiting times against optimal waiting times based on clinical urgency.
• To identify potential inefficiencies in the coronary revascularisation waiting list process.

Main Methods:

• A retrospective audit of 92 patients referred for CABG or PTCA between January and April 1990 in Christchurch.
• Case records were reviewed to determine urgency scores based on angina severity and coronary anatomy.
• Actual waiting times were compared with a calculated optimal waiting time.

Main Results:

• Only 16% of patients referred for CABG received the procedure within the optimal timeframe, with a mean waiting time of 163 days.
• For percutaneous transluminal angioplasty (PTCA), 53% of patients were treated within the optimal period, with a mean waiting time of 80 days.
• A significant proportion of patients, particularly those awaiting CABG, experienced prolonged delays, irrespective of disease severity or angina class.

Conclusions:

• Waiting times for coronary revascularisation are unacceptably long, even for patients with high-risk clinical indicators.
• Implementing prospective monitoring of waiting lists using standardized urgency rating scores is recommended.
• This approach can provide valuable insights into waiting list dynamics and inform resource allocation strategies, including the analysis of service rationing.