Waiting for Specialists: A Multi-Priority and Multi-Speciality Analysis.

Area of Science:

• Health Services Research
• Healthcare Management
• Operations Research in Healthcare

Background:

• Managing outpatient specialist consultation waiting times is a global healthcare challenge.
• Multi-priority systems are employed to balance access and efficiency.

Purpose of the Study:

• To analyze how hospitals manage outpatient specialist consultation waiting times using multi-priority systems.
• To investigate the impact of operational factors and policy reforms on waiting times across different priority levels.

Main Methods:

• Analysis of nearly one million consultations across 29 specialties at a Portuguese hospital (2010-2019).
• Utilized fixed-effects models with Driscoll-Kraay standard errors to assess operational factors.
• Examined cross-priority effects and the impact of a 2017 policy reform.

Main Results:

• Triage delays significantly increase waiting times, especially for routine cases.
• Increased staffing primarily benefits routine consultations.
• Backlogs in high-priority cases negatively impact lower-priority waits.
• Provider cancellations disproportionately affect lower-priority cases.
• A 2017 policy reform led to specialty-specific adaptations and increased overall waiting times, with cardiac units showing improved efficiency.

Conclusions:

• Hospitals balance clinical prioritization with system efficiency, with specialty constraints influencing access.
• Targeted resource allocation and adaptive triage systems are crucial for managing waiting times while maintaining clinical priorities.