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Surgical waiting times and patient choice: how much delay do patients really want?
Vivak Chander Hansrani1, Angus Fong, Nicholas Ferran
1Musculoskeletal Department, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Groby Road, Leicester, LE3 9QP, UK, vchansrani@doctors.org.uk.
Background:
The 18-week target to treatment government initiative was implemented in 2004. In order for this to work, patients need to accept operative dates provided, otherwise the pathway will fail.
Aim:
The aim of this prospective study was to identify the earliest time patients would accept surgical intervention following assessment at an outpatient clinic and to identify the reasons why some patients would choose to delay surgery.
Methods:
This prospective study was carried out at an elective orthopaedic centre over a 5-month period. All new adult referrals to the department were asked to complete a seven-point questionnaire on waiting time preference and possible reasons for delaying surgery. No paediatric or spinal orthopaedics was carried out at the centre.
Results:
A total of 73 % of the 797 questionnaires were completed. Up to 16 % of patients could not accept day-case/inpatient operation within 6 weeks. Work commitment was the most common reason for choosing to delay surgery, with nearly 50 % of employed patients citing it as a reason. No significant difference was identified between inpatient and day-case procedures.
Conclusion:
There is a risk that operative slots will be unfilled within the 18-week pathway. 18 % of patients will potentially refuse an operative date offered within 6 weeks of their outpatient visit. Work, holidays and care arrangements are important in uptake. A proactive strategy to improve the uptake of offered surgery is required to prevent operating slots being underutilised.
Insights
Many patients delay elective orthopaedic surgery due to work commitments, potentially leaving operating slots unfilled. A proactive strategy is needed to improve surgical uptake within the 18-week target to treatment pathway.
Area of Science:
- Healthcare Management
- Orthopaedic Surgery
- Patient Pathways
Background:
- The UK government's 18-week target to treatment initiative (implemented 2004) relies on patient acceptance of surgical dates.
- Failure to accept offered dates can disrupt patient pathways and lead to underutilised operating slots.
Purpose of the Study:
- To determine the earliest acceptable timeframe for surgical intervention post-outpatient assessment.
- To identify patient-related factors influencing delays in elective orthopaedic surgery.
Main Methods:
- A prospective study conducted at an elective orthopaedic centre over five months.
- 797 new adult referrals completed a seven-point questionnaire on waiting time preferences and reasons for delay.
- Paediatric and spinal orthopaedic cases were excluded.
Main Results:
- 73% of questionnaires were completed, with 16% of patients unable to accept surgery within six weeks.
- Work commitments were the primary reason for delay, cited by nearly 50% of employed patients.
- No significant difference in acceptance was noted between day-case and inpatient procedures.
Conclusions:
- A significant percentage of patients (18%) may refuse surgery offered within six weeks, risking unfilled operating slots.
- Patient work schedules, holiday plans, and care arrangements significantly impact surgical uptake.
- Proactive strategies are essential to enhance the acceptance of offered surgical dates and prevent operating theatre underutilisation.
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