Prioritizing Patients for Prostatectomy: Balancing Clinical and Psychosocial Factors

Curtis, Andrea J.; Wolfe, Rory; Russell, Colin; Costello, Anthony J.; Travis, Douglas; Snow, Ross; McNeil, John J

doi:10.1111/j.1445-2197.2006.03988.x

Cited by 5 publications

(3 citation statements)

References 15 publications

(39 reference statements)

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“…The Victorian Waiting List Prioritisation Study used WCWL questionnaires as a starting point to develop Australian tools suitable for prioritising local patients for total hip or knee replacement and prostatectomy 32 . Ranking and rating exercises performed by medical professionals and laypeople using real patient vignettes showed that clinical symptoms and psychosocial criteria were considered equally important when assessing a patient's urgency for surgery 33 . This information provided the foundation for prioritisation tool frameworks.…”

Section: Research In Victoriamentioning

confidence: 97%

Waiting lists and elective surgery: ordering the queue

Curtis

Russell

Stoelwinder

et al. 2010

Medical Journal of Australia

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In the Australian public health system, access to elective surgery is rationed through the use of waiting lists in which patients are assigned to broad urgency categories. Surgeons are principally responsible for referring patients to waiting lists, deciding on the appropriate urgency category, and selecting patients from the waiting list to receive surgery. There are few agreed‐upon criteria to help surgeons make these decisions, leading to striking differences between institutions in proportions of patients allocated to urgency categories. In other countries with publicly funded health systems, programs have been developed that aim to make prioritisation more consistent and access to surgery more equitable. As demand for health care increases, similar programs should be established in Australia using relevant clinical and psychosocial factors. Prioritisation methodology adapted for elective surgery may have a role in prioritising high‐demand procedures in other areas of health care.

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Section: Research In Victoriamentioning

confidence: 97%

Waiting lists and elective surgery: ordering the queue

Curtis

Russell

Stoelwinder

et al. 2010

Medical Journal of Australia

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“…The elective surgery system Priority scoring system Priority scoring system Priority scoring system Priority scoring system observed in South Australian hospitals was congruent with the overview of the Australian elective surgery system described by Curtis (2007). 24 Following the analogy of a snakes and ladders game, no single snake was identified that, if removed, would smooth the path to timely delivery of THR or TKR surgery in South Australia. The system snakes were clearly interlinked and together resulted in inefficient processes, patient and employee dissatisfaction, cancellations and, ultimately, long waiting times.…”

Section: Discussionmentioning

confidence: 79%

Snakes and ladders: the barriers and facilitators of elective hip- and knee-replacement surgery in Australian public hospitals

Walters

Mackintosh

Sheppard

2013

Aust. Health Review

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Objectives. Waiting lists for elective surgery are a persistent problem faced by health systems. The progression through elective surgery waiting lists can be likened to a game of snakes and ladders where barriers (snakes) delay access to surgery and facilitators (ladders) expedite access. The aim of the present study was to describe the barriers and facilitators to delivery of total hip-and total knee-replacement surgery in South Australian public-funded hospitals.Methods. Semistructured interviews with staff, direct observation of administrative processes and documentation analysis were combined under a systems theory framework.Results. System barriers (snakes) were grouped into five categories: resources, workload, hospital engagement, community engagement and system processes. Inadequate resources was the most prominent barrier, patient cancellations resulted in one-third of administrative tasks being repeated and there was a perceived lack of engagement to maximising efficiency. Interestingly, despite a lack of resources being perceived to be the biggest problem, additional resources without system change was not considered an effective long-term strategy.Conclusions. Given the complexity of the elective surgery system, it is not surprising that single-item reforms have not created lasting reductions in waiting times. Multifaceted, whole-system reforms may be more successful.What is known about the topic? Waiting lists and waiting times for surgery are controversial, associated with frequent reforms and negative emotive headlines. We know from existing literature and anecdotal reports that individuals frequently experience lengthy delays before receiving elective surgery. Anecdotal reports also suggest that there are inefficiencies within elective surgery systems that contribute to these delays and result in cancellations, patient deterioration and poor overall satisfaction with the public health system in Australia. What isn't clear is whether this perception is accurate and what inefficiencies do exist that could be specifically targeted for reform. What does this paper add? This paper adds weight to the argument that some inefficiencies exist within elective surgery systems, and identifies specific barriers to the delivery of total hip-and total knee-replacement surgery in South Australian public hospitals. It also identifies several strategies that could improve system function, some of which have already been implemented at a local level in response to stress on the system, and some of which require broad region-or state-wide change. In contrast to existing research, the level of detail provided in the present paper should allow for targeted reforms with the potential to improve system function and the efficiency with which joint-replacement surgery can be delivered. What are the implications for practitioners? All clinicians aim to provide the best intervention for their patients. Should the findings of this study be used to inform elective surgery system changes, patients and clinicians shoul...

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“…Our study method is outlined in Box 1, following the general method described elsewhere. 12 The Alfred Hospital Human Research Ethics Committee approved this study. Patients gave informed consent to be included in the study.…”

Section: Methodsmentioning

confidence: 99%

Determining priority for joint replacement: comparing the views of orthopaedic surgeons and other professionals

Curtis

Wolfe

Russell

et al. 2011

Medical Journal of Australia

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Objective: To assess which patient characteristics influence the assessments of urgency for surgery by orthopaedic surgeons and non‐orthopaedic professionals. Design, setting and participants: Cross‐sectional study of 80 patients requiring elective hip or knee replacement attending a public hospital orthopaedic outpatient clinic or orthopaedic surgeon's private rooms. Patients were interviewed after being placed on the surgery waiting list. The interview asked about the severity of their joint disease and its effects on physical capability, psychological distress and social circumstances. Patient interviews were summarised and presented to assessors who ranked groups of eight patients in order of their perceived urgency for surgery. Eleven orthopaedic surgeon assessors completed 360 patient ratings and nine non‐orthopaedic assessors from various professions, including physiotherapy, social work, research, management and engineering, completed 720 patient ratings. Main outcome measures: Visual analogue scale rating of patient urgency for surgery; patient rankings for surgery; scores for individual domain contributions to urgency rating. Results: A broad spread of perceived urgency was evident among the patients. For each group of eight patients, there was moderate agreement on overall urgency rankings between the two groups of assessors. Linear regression demonstrated that pain was the dominant determinant of urgency score for both assessor groups. Orthopaedic surgeons also took into account limitations to mobility and concurrent medical illness but gave less priority to psychological distress or social circumstances. For the non‐orthopaedic assessors, limitations to mobility, social circumstances and psychological distress also contributed to urgency. Conclusion: Both orthopaedic surgeons and non‐orthopaedic professionals considered pain the most important factor in establishing urgency and priority for joint replacement. Only the non‐orthopaedic professionals considered psychosocial factors important when determining priority for surgery. Broader community discussion about prioritisation for elective surgery is needed to facilitate agreement about which patients factors should be considered.

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Prioritizing Patients for Prostatectomy: Balancing Clinical and Psychosocial Factors

Cited by 5 publications

References 15 publications

Waiting lists and elective surgery: ordering the queue

Waiting lists and elective surgery: ordering the queue

Snakes and ladders: the barriers and facilitators of elective hip- and knee-replacement surgery in Australian public hospitals

Determining priority for joint replacement: comparing the views of orthopaedic surgeons and other professionals

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