Table 2

Study results, conclusions and limitations

Ramchandani et al (2002)5Acceptability
  • Pts: 82% of Pts expressed willingness to change consultants in order to get an earlier operation by a surgeon of equal quality

  • GPs: 92% favoured pooled lists; 8% were against

  • Consultant ophthalmologists: 30% favoured (for routine cases) and 67% were against pooled

  • Small sample sizes for Pts and GPs

  • Low response consultant survey (64%)—views of responders may differ from those of non-responders (non-response bias)

  • Views of urban GPs may not reflect those of rural GPs

Leach et al (2004)33Accessibility
  • Time from scan to outpatient review (total WT) was initially 185 days, reduced to 30 days following use of pooled lists

  • Before introduction of pooled waiting lists, 37% of Pts waited for more than 9 months—this fell to 0

  • Limited data presented

  • Source of preimplementation/postimplementation data not clear

  • Total number of Pts, WT1 and WT2 data is not available

Singh et al (2005)31Accessibility
  • Waiting lists for the selected procedures were cleared, especially longest waiters

  • Pt throughput improved; number of the selected surgical procedures performed doubled

Cost: operating costs were reduced by 25% (largely due to reduced length of stay); no recorded adverse Pt outcomes Acceptability
  • 91% of Pts felt the process was clearly explained to them; 65% felt a definite date of surgery was most important

  • 40% did not mind that their consulting and operating surgeons were different

  • Small scale complex intervention with many variables, difficult to assess association between WT reduction and use of single-entry components

  • No definitions or data provided for waiting times

  • Comparison of groups from different populations; survey sent to one group (control group based on historical data)

  • Low questionnaire response rate—no measure of overall satisfaction; probable non-response bias

Sir-Ram et al (2005)32Accessibility
  • Mean total WT from referral to surgery in group 1 (direct booking service) was 70 days (range 10–177), much shorter than for group 2 (control)

  • Group 2 mean WT1 was 77 days; WT2 84.2 days, total WT 161.2 days (p<0.05)

  • 94% of respondents would recommend the direct booking service to a friend

  • Survey only sent to one group (control group was based on historical data)

  • Comparison of groups from different populations

  • Low questionnaire response rate

  • Probable non-response bias

Vasilakis et al (2007)30Accessibility
  • Pooled lists reduced mean number of Pts waiting on the list by 30%, compared with individual referrals

  • Twice as many Pts had appointments within 12 weeks of referral through pooled vs individual surgeon referrals

  • Pooled referrals reduced WT1 among longest waiters

  • Pooled referrals increased WT2 for non-urgent cases; no impact on urgent and semiurgent Pts or on total WT

  • Regardless of referral method, odds of surgery for Pts was equal within 18 weeks

  • Simulation models may not be true representations of clinical scenarios

  • Unable to capture nuances of complex interventions

Bungard et al (2008)26
  • New collaborative model involves a single point-of-entry, intake and triage mechanism with a multidisciplinary team to ensure only one visit (rather than repeated) with cardiologist

  • Traditional referral patterns still respected

  • NA

Cipriano et al (2008)27Accessibility
  • Clinically prioritising Pts reduced WTs for high-priority Pts and increased the number of Pts in all priority levels receiving surgery within maximum recommended WTs

  • 90% of Pts received surgery within benchmark—achieved 1 year earlier

  • Common waiting lists resulted in increased efficiency, equity in WT across regions and reduced waiting times in the long term

  • Regional variation in WTs was reduced

  • Simulation models may not be true representations of clinical scenarios

  • Reporting by surgeons to the OJRR is voluntary therefore data may not be fully representative

Bichel et al (2009)24Accessibility
  • Participating clinics demonstrated varying results

  • Centralised access and triage decreased WTs and enabled timely access for Pts requiring urgent care (seen based on urgency rather than for specific surgeon)

  • WTs decreased in spite of increased number of monthly Pt referrals and acceptance rate for most clinics

  • WTs for consultation decreased from a mean (SD) of 29 (±46) to 17 (±14) days (p<0.05) for urgent-level referrals, from 110 (±57) to 63 (±42) days (p<0.00005) for moderate-level referrals, and from 155 (±88) to 108 (±37) days for routine-level referrals, respectively, between 2005 and 2008

Efficiency: pooling of referrals eliminated duplicate referralsEquity: WTs for each physician equalised
  • Limited description of methods employed

  • Sampling technique, sample size not provided

  • Preimplementation data (for comparisons) was not available for all groups

Bungard et al (2009)25Accessibility
  • Pts were seen significantly sooner in each year of Cardiac EASE compared with pre-EASE period (p<0.0001)

  • The mean WT from referral to specialist consultation (WT1) was reduced from 71±45 days in the pre-EASE group to 33±19 days in the EASE group (p<0.0001)

  • Cardiac EASE Pts had a significantly shorter wait to definitive diagnostic decision and treatment plan (WT2) compared with pre-EASE (51± days and 120±86 days, respectively)

  • Increased Pt volume through Cardiac EASE (∼50% from 2004 to 2005; 19% from 2005 to 2006)

  • Complex intervention with many variables, difficult to assess association between WT reduction and use of single-entry components

  • Comparison of groups from different populations

  • Historical group has a small sample size compared with that of the intervention group

  • Treatment effect may be present

Macleod et al (2009)28Accessibility
  • 90% of Pts waited <115 days for hip or knee replacement surgery (WT2; less than provincial target of 182 days); WT1 was <100 days

  • Little empirical evidence for results cited

  • No comparison provided to specific previous WTs/scenarios

van den Heuvel (2012)29Accessibility
  • 94/236 (40%) Pts responded—67% had the same surgeon for assessment and surgery; 31% had a different surgeon (next-available)

  • Almost half of respondents (48%) did not understand that choosing a specific surgeon may result in longer waiting times

  • No difference in postoperative complication rates between groups

  • WTs from referral to initial consult in the hernia clinic (WT1) decreased from 208 to 59 days (2007–2009)

  • Two thirds of Pts had confidence in the competence of any surgeon and were comfortable having their surgery performed by a surgeon they meet on the day of surgery

  • Even if Pts have a different surgeon for their operation than for their assessment, their confidence is high (86.2%)

  • Most Pts felts that service is faster and better in a specialised centre (like the hernia clinic being evaluated)

  • Low questionnaire response rate—results may not be generalisable

  • Probable non-response bias

  • EASE, Ensuring Access and Speedy Evaluation; GP, general practitioner; NA, not available; OJRR, Ontario Joint Replacement Registry; Pt, patient; WT, waiting time; WT1, time from referral to initial consult; WT2, time from consult to procedure date.