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Reducing waiting times for pediatric adenotonsillectomy through a value-based healthcare service redesign: an
Izabela Marcewicz-Jendrysik1, Łukasz Wicherek2, Magdalena Dutsch-Wicherek3
1Eleonora Reicher National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland.
Insights
Value-based healthcare (VBHC) redesign using an integrated practice unit (IPU) significantly reduced pediatric adenotonsillectomy waiting times. This approach improved surgical efficiency and patient access in publicly funded otolaryngology services.
Area of Science:
- Healthcare Management
- Pediatric Surgery
- Value-Based Healthcare
Background:
- Fragmented care, inefficient operating room (OR) capacity, and long surgical wait times impact publicly funded pediatric otolaryngology services.
- A service redesign using a value-based healthcare (VBHC) model, centered on an integrated practice unit (IPU), was evaluated for its potential to enhance patient access to pediatric adenotonsillectomy in Warsaw.
Purpose of the Study:
- To assess the impact of a VBHC-informed IPU redesign on access to pediatric adenotonsillectomy.
- To evaluate improvements in waiting times, surgical throughput, and resource utilization.
Main Methods:
- An implementation evaluation was conducted at Warsaw Hospital for Children, launching an IPU-based program in October 2022.
- The program incorporated standardized care pathways, multidisciplinary assessments, centralized scheduling, enhanced parent communication, and patient-reported outcome monitoring.
- Interrupted time series analysis with segmented regression was used to evaluate changes in median waiting times.
Main Results:
- Median waiting times for pediatric otolaryngology surgery decreased from 56 weeks in 2022 to 4 weeks in 2024.
- Surgical throughput increased significantly, with the median monthly number of procedures rising from 32 to 65.
- Lost OR slots decreased from 27 to 11, and readmissions remained rare (3 per 2500 procedures).
Conclusions:
- A VBHC-informed IPU redesign effectively reduced waiting times for pediatric adenotonsillectomy.
- The redesign improved OR utilization and surgical throughput while maintaining safety outcomes.
- This model offers a promising strategy for enhancing access and efficiency in pediatric surgical services.
Background:
Publicly funded pediatric otolaryngology services may be affected by fragmented care pathways, inefficient use of operating capacity, and long waiting times for surgery. We evaluated whether a value-based healthcare (VBHC) service redesign, organized around an integrated practice unit (IPU), could improve access to pediatric adenotonsillectomy in Warsaw.
Methods:
We conducted an implementation evaluation at Warsaw Hospital for Children. The IPU-based program was launched in October 2022 and included standardized care pathways, multidisciplinary assessment, centralized scheduling, parent communication, and monitoring of patient-reported experience and outcomes. The primary outcome was monthly median waiting time for elective pediatric otolaryngology surgery. Secondary outcomes included surgical throughput, lost operating room slots, bed use, length of stay, and readmissions. Interrupted time series analysis using segmented regression assessed changes in waiting time.
Results:
Between October 2022 and October 2024, 2500 children aged 0-18 years were treated within the program. Median waiting time decreased from 56 weeks in 2022 to 12 weeks in January-June 2023, 6 weeks in July-December 2023, and 4 weeks in 2024. Interrupted time series analysis showed a significant immediate reduction after implementation (β = -36.26 weeks; 95% CI -51.74 to -20.78; p < 0.001). Surgical throughput increased, with the median monthly number of procedures during October-December rising from 32 in 2022 to 51 in 2023 and 65 in 2024. Lost operating room slots decreased from 27 to 11. Readmissions were rare, with three events recorded among 2500 procedures.
Conclusions:
A VBHC-informed IPU redesign was associated with shorter waiting times, improved operating room utilization, increased surgical throughput, and stable safety outcomes.