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What is the influence of single-entry models on access to elective surgical procedures? A systematic review
  1. Zaheed Damani,
  2. Barbara Conner-Spady,
  3. Tina Nash,
  4. Henry Tom Stelfox,
  5. Tom W Noseworthy,
  6. Deborah A Marshall
  1. Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
  1. Correspondence to Dr Deborah A Marshall; damarsha{at}


Background Single-entry models (SEMs) for the management of patients awaiting elective surgical services are designed to increase access and flow through the system of care. We assessed scope of use and influence of SEMs on access (waiting times/throughput) and patient-centredness (patient/provider acceptability).

Methods Systematic review of articles published in 6 relevant electronic databases included studies from database inception to July 2016. Included studies needed to (1) report on the nature of the SEM; (2) specify elective service and (3) address at least 1 of 3 research questions related to (1) scope of use of SEMs; (2) influence on timeliness and access; (3) patient-centredness and acceptability. Article quality was assessed using a modified Downs and Black checklist.

Results 11 studies from Canada, Australia and the UK were included with mostly weak observational design—2 simulations, 5 before–after, 2 descriptive and 2 cross-sectional studies. 9 studies showed a decrease in patient waiting times; 6 showed that more patients were meeting benchmark waiting times; and 5 demonstrated that waiting lists decreased using an SEM as compared with controls. Patient acceptability was examined in 6 studies, with high levels of satisfaction reported. Acceptability among general practitioners/surgeons was mixed, as reported in 1 study. Research varied widely in design, scope, reported outcomes and overall quality.

Conclusions This is the first review to assess the influence of SEMs on access to elective surgery for adults. This review demonstrates a potential ability for SEMs to improve timeliness and patient-centredness of elective services; however, the small number of low-quality studies available does not support firm conclusions about the effectiveness of SEMs to improve access. Further evaluation with higher quality designs and rigour is required.

  • Health Services Accessibility
  • Waiting lists
  • Elective Surgical Procedures

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  • Contributors ZD initiated and contributed to the design of the collaborative project; collected and analysed the data; drafted, revised and finalised the draft paper and is also the guarantor. BC-S designed data collection tools; collected, analysed and monitored data collection and revised the draft paper. TN contributed to the design of the collaborative project; collected and analysed the data; drafted and revised the draft paper. HTS contributed to the design of the collaborative project; monitored data collection and revised the draft paper. TWN initiated the collaborative project, monitored data collection and analysis and revised the draft paper. DAM contributed to the design of the collaborative project, monitored data collection and revised the paper. All authors approved the final version of the paper for submission.

  • Funding This research was supported by CIHR Emerging Team Grant 92252.

  • Competing interests TN reports that she is the programme facilitator for Alberta Health Services. DAM reports other from Canada Research Chair, Health Services and Systems Research, other from Arthur J.E. Child Chair in Rheumatology Outcomes Research, during the conduct of the study; personal fees from Abbvie, personal fees from Janssen, personal fees from Novartis, personal fees from Optum Insight, outside the submitted work. The content (in part) was prepared for a poster presentation by ZD at the 35th Annual North American Meeting of the Society for Medical Decision Making (SMDM); Baltimore, MD: 23 October 2013. The abstract was subsequently published as follows: Damani Z, Conner-Spady B, Noseworthy T. P4-39 Value and Acceptability of Single-Entry Models in Health Care (Abstract). Med Decis Making. February 2014;34(2):E129.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement As this is a systematic review, all data extracted for the source articles in the literature are contained within our data tables.

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