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Measuring the quality of performance in the management of waiting lists: using cataract surgery as an example
H D Hadjistavropoulos1, B Snider, G Bartlett
1Department of Psychology, University of Regina, Saskatchewan, Canada. hhadjistavropoulos@reginahealth.sk.ca
Insights
Ophthalmologists effectively managed cataract surgery waiting lists through individual physician judgment, with minimal patient concern and no negative impact on outcomes. Formal criteria could further enhance prioritization, but current practices are largely adequate.
Area of Science:
- Ophthalmology
- Healthcare Management
- Patient Outcomes
Background:
- Waiting lists are crucial for quality of care, yet often lack explicit prioritization criteria.
- Ophthalmologists' decision-making in managing cataract surgery waiting lists was examined.
- Cataract surgery represents a high-volume elective procedure with significant patient impact.
Purpose of the Study:
- To evaluate the quality of ophthalmologists' decisions in managing cataract surgery waiting lists.
- To assess patient experiences and concerns regarding waiting periods for cataract surgery.
- To determine if patient-specific factors influence waiting times.
Main Methods:
- Ninety-eight patients undergoing cataract surgery were interviewed pre- and postoperatively.
- Data collected included cataract symptomatology, visual and emotional functioning, coping strategies, and waiting period concerns.
- Ophthalmologists provided preoperative and postoperative visual functioning data.
Main Results:
- Wait times generally aligned with ophthalmologists' consensus standards, with patient preference also playing a role.
- Patients reported minimal concerns and functional difficulties related to waiting periods.
- Surgery outcomes were not negatively impacted by waiting times; visual acuity did not predict wait duration.
Conclusions:
- Individual physician decision-making can effectively manage waiting lists for cataract surgery.
- Explicit, formal decision-making rules could provide additional benefits for prioritization.
- Further analysis can identify optimal criteria for prioritizing patients on surgical waiting lists.
Background:
Quality of care committees monitor waiting lists to ensure that patient care is not compromised. Frequently, waiting lists are determined by individual physicians, and no explicit criteria determine who is first in the queue. The quality of ophthalmologists' decisions for managing waiting lists of cataract patients, a high-volume elective patient group, was examined in a study of patients undergoing cataract surgery in 1997 in the Regina Health District, Saskatchewan, Canada.
Method:
Ninety-eight patients scheduled for surgery were interviewed pre- and postoperatively regarding cataract symptomatology, visual and emotional functioning, coping strategies, and concerns with waiting periods. Ophthalmologists provided preoperative and postoperative information on visual functioning.
Results:
Even though no formal criteria guided decision making about how long patients should wait, wait periods conformed to general standards set by consensus of ophthalmologists unless patients decided to delay surgery. Patients voiced little concern about the waiting period, and difficulties with visual and emotional functioning were minimal. Surgery outcomes were not negatively affected by waiting periods, which were in part a function of physician case load but were also related to patient preference and the tendency to seek out reassurance. Visual acuity, cataract symptomatology, and visual functioning were not predictive of waiting time, suggesting that this information is not consistently being used to prioritize patients.
Conclusion:
Waiting lists can be well managed by using individual physician decision making, although explicit formal decision-making rules would be helpful. A variety of methodologies and analyses can be used to evaluate the management of waiting lists and to assist in identifying criteria for assigning priority to patients.