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Managing scarce services. A waiting list approach to cardiac catheterization
A L Morris1, L L Roos, R Brazauskas
1Department of Medicine, St. Boniface General Hospital, Winnipeg, Manitoba, Canada.
Insights
Manitoba
Area of Science:
- Cardiovascular Medicine
- Health Services Research
- Medical Economics
Background:
- Healthcare systems face challenges when demand for services outstrips availability.
- Waiting lists are common for cardiovascular services, necessitating prioritization strategies.
- Assessing patient urgency is critical for equitable and effective healthcare delivery.
Purpose of the Study:
- To evaluate the prioritization of cardiac catheterization based on patient urgency within a healthcare system experiencing high demand.
- To determine if the waiting list process effectively identified and managed patients with the greatest need for immediate cardiac catheterization.
- To analyze clinical differences between patients categorized for elective versus immediate cardiac catheterization.
Main Methods:
- Retrospective analysis of hospital records for 871 patients undergoing cardiac catheterization between May 1981 and December 1982.
- Categorization of patients into "Elective Care" (N=557) and "Immediate Care" (N=314) groups.
- Assessment of patient urgency and clinical characteristics, including New York Heart Association (NYHA) functional classification.
Main Results:
- Immediate Care patients presented with more severe conditions, including acute congestive heart failure, prior aortic valve surgery, and chronic obstructive pulmonary disease.
- Immediate Care patients were more likely to be in NYHA Class 4, admitted via the Emergency Room, experience longer hospital stays, and have higher in-hospital mortality.
- Despite high demand, critical events like cardiac arrest, acute myocardial infarction, and death among patients awaiting catheterization were infrequent.
Conclusions:
- The cardiac catheterization waiting list process in this Manitoba hospital appeared to function effectively in prioritizing urgent cases.
- The system successfully differentiated between patients requiring immediate intervention and those who could safely wait.
- This study highlights the importance of robust prioritization protocols in managing cardiovascular service waiting lists.
Abstract:
Relatively little attention has been directed to the provision of health care services when demand exceeds availability. Since "waiting lists" are characteristic of the delivery of cardiovascular services in Manitoba, we hypothesized that the highest priority would be given to cases with the greatest urgency. This study examined the waiting lists for cardiac catheterization in one of two tertiary health care facilities offering comprehensive cardiovascular care to a population of slightly more than one million persons. Hospital records of all patients undergoing cardiac catheterization from May 1981 through December 1982 were abstracted retrospectively. For 871 patients entering a catheterization laboratory by two different routes (Elective Care, N = 557; Immediate Care, N = 314), patient need for immediate catheterization was assessed. Clinical differences between patients in the two groups were striking. Immediate Care patients more frequently had acute congestive heart failure, prior aortic valve surgery, and chronic obstructive pulmonary disease. Immediate Care patients were most frequently in Class 4 of the NYHA functional classification and were more often treated with triple medical therapy. These clinically ill individuals were more likely to enter the hospital via the Emergency Room; they were more likely to have long hospital stays and to die in hospital. As implemented in one Manitoba hospital, the waiting list process appears to have worked fairly well; cardiac arrest, acute myocardial infarction, and death among patients waiting for catheterization were all rare events. Both those patients needing immediate care and those who could wait with a low probability of a poor outcome were successfully identified.(ABSTRACT TRUNCATED AT 250 WORDS)
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