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Achieving 18-week waiting times in elective hand surgery
Cb Chuo1, Tc Wright, E Breuning
1Department of Plastic Surgery, Selly Oak Hospital , Raddlebarn Road, Selly Oak, Birmingham B29 6JD , UK.
JRSM Short Reports
|November 25, 2010
Summary
This audit found that while direct referrals improved, indirect referrals for hand surgery still exceeded the 18-week target. Improving GP awareness and multi-specialty collaboration are key to reducing wait times.
Area of Science:
- Healthcare Management
- Surgical Referral Systems
- Patient Waiting Times
Background:
- The UK Department of Health mandated an 18-week referral-to-treatment time (RTT) target for high-quality healthcare by December 2008.
- Elective hand surgery referrals in 2007 were categorized as direct (from general practitioners) or indirect (from other specialties).
Purpose of the Study:
- To audit the referral-to-treatment time (RTT) for elective hand surgery patients.
- To assess the feasibility of achieving the 18-week RTT target in hand surgery.
Main Methods:
- Prospective and retrospective audit of RTT for 152 elective hand surgery patients in 2007.
- Post-audit engagement with managers of referral systems ('Choose & Book', 'Action on Orthopaedics') and referring clinicians.
- Repeat prospective audit of 94 patients in 2008 to evaluate changes.
Main Results:
- Mean RTT for direct referrals decreased from 15 to 12 weeks.
- Mean RTT for indirect referrals decreased from 43 to 24 weeks, remaining statistically significant (p < 0.0001) in both audit cycles.
- Despite improvements, indirect referrals did not meet the 18-week target.
Conclusions:
- Efforts to reduce RTT did not bring average indirect referral times within government targets.
- Increasing general practitioner (GP) awareness of referral system limitations and local service availability may reduce inappropriate referrals.
- A multi-specialty approach is essential to expedite hand surgery referrals to plastic surgery services.