Understanding Surgical Waiting Lists: A Comprehensive Guide
1. What is a Waiting List (LE)?
A waiting list (LE) refers to the group of patients who, at a specific time, are awaiting a particular healthcare service and whose delay in receiving care is not medically indicated.
2. Common Types of Waiting Lists
The most common types of waiting lists include:
- Outpatient consultations in specialized care
- Medical or surgical hospital admissions
- Diagnostic tests
3. Measuring Delay in Waiting Lists
Delay in a waiting list is measured as the difference in time between:
- The receipt and registration of medical indications for the service
- The time the service is delivered or offered
4. Exclusions from Waiting Lists
The concept of “medically indicated” delay excludes certain situations from being considered waiting list cases. Examples include:
- Scheduled admissions for medical reasons at a specific time (e.g., colostomy reconstruction)
- Admissions during successive stages of a therapeutic process (e.g., chemotherapy cycles)
- Successive consultations
- Patients who request a delay in receiving care
5. Causes of Waiting Lists
Waiting lists occur due to an imbalance between the demand for healthcare services and the actual supply of those services at a given time and place.
LE = Demand – Supply
6. Objectives of SADC in Surgical Waiting List (LEQ) Management
The objectives of the Surgical Activity Department Coordination (SADC) in managing surgical waiting lists include:
- Providing information to users
- Optimizing resources in the surgical area
7. Data Provided by SADC Regarding LEQ
The SADC provides both quantitative and qualitative data on surgical waiting lists.
Quantitative Data:
- Total number of patients and their distribution by service, waiting time intervals, average delay, and geographical origin
- Number of patients who refuse surgery
- Number of patients medically excluded from the waiting list
Qualitative Data:
- Distribution of patients by diagnosis and social impact (e.g., temporary disability days)
- Number of surgery hours on the waiting list
- Number of holidays on the waiting list
- Evolution of the waiting list: Number of patients included, annual trends, distribution by service, diagnosis, geographical origin, operating time, and number of rooms
8. Ensuring Proper Management of Patients on Waiting Lists
To ensure proper management of patients on waiting lists, it is crucial to establish uniform standards and objectives that consider both medical and social aspects.
Medical Aspects:
- Probability of complications evolving over time
- Correlation between disease prognosis and treatment delay
Social Aspects:
- Level of functional disability
- Relationship and disability level
- Anxiety
9. Attention to Members
Performance standards related to hospital surgical activity should not negatively impact patients.
10. Particular Attention to the User
Key aspects of user-centered care include:
- Maintaining a single waiting list for the surgical area
- Preparing the patient from the moment surgery is indicated
- Providing information on expected delays and reasons
- Assessing changes in the patient’s clinical condition
- Giving advance notice of surgery
- Avoiding cancelled surgeries due to non-medical reasons
11. Factors Influencing SADC Optimization of Surgical Resources
The SADC can influence both supply and demand factors in managing waiting lists, although its impact on demand is less effective.
12. Basic Resources for LEQ Organization and Management
- Master file of operating rooms
- Report on the status of pending operations
- Planning of scheduled interventions
- Registration statements and other necessary organizational resources
13. Basic Processes in LEQ Management
- Authorization for inclusion on the waiting list based on criteria such as geographical origin, care provenance, preoperative diagnosis, and data compliance
- Exclusion from the waiting list due to surgery completion or patient/service decision, with proper documentation
- Forecasting the surgical schedule from the waiting list by the SADC and surgical service
- Patient notification and preoperative preparation
- Forecasting bed reservation and admission date
- Surgical closure and patient notification
- Confirmation of bed and surgical admission
- Collection of data related to surgical corrections
- Preparation of data tables
14. Surgery Schedule Preparation
The selection of patients for surgery is a critical task often requiring the surgeon’s expertise and autonomy. This process involves considering the complexity of patients, diagnoses, proposed surgical procedures, and various other variables to create a balanced and efficient schedule. Collaboration between the surgeon and the SADC is essential.
15. Models for Surgery Schedule Preparation
Different models exist for preparing surgery schedules, including:
- Independent programming by the SADC, with or without subsequent verification
- Program committees
- Secretariats of general surgical clinics, with or without a medical coordinator
- Automatic programming with preset combinations of procedures
16. Operative Note Closure
The operative note should be closed at least 48-72 hours in advance, ensuring the patient is informed and admitted.