Access to elective vascular surgery within the recommended time according to emergency referrals

Sobolev, Boris; Brown, Peter; Zelt, David; Shortt, Samuel
October 2001
Clinical & Investigative Medicine;Oct2001, Vol. 24 Issue 5, p236
Academic Journal
Background: Referral pattern is a potential confounding factor when waiting-list performance is reported across hospitals or periods. A common concern is the ability to accurately estimate proportions of patients undergoing surgery in the recommended time without considering emergency caseload. In this study, the relation between emergency referrals and the rate of elective admissions to hospital within the recommended time was estimated. Design: A prospective cohort study. Setting: An acute care hospital in Kingston, Ont. Patients: Between 1994 and 1999, 1173 consecutive patients accepted for elective vascular surgery. Main outcome measures: The proportion of patients who underwent surgery within the recommended time, and time to surgery. Study variables: The weekly number of emergency cases, enrollment periods, urgency and type of surgery. Results: Overall, the proportion of patients who underwent surgery within recommended time was 0.45, (95% confidence interval [CI], 0.42-0.48). Adjusted for enrolment period, urgency and type of surgery, the estimated proportion was 0.57, (95% CI, 0.49-0.64). Compared with surgery for peripheral vascular disease, the odds of the procedure being done within the recommended time were 34% lower for aortic abdominal aneurysm repair and 41% lower for carotid endarterectomy. After adjustment for the case-mix and access attributes, the rate of elective admission within recommended time was on average 30% lower for weeks in which there were 1 to 2 emergency cases (rate ratio [RR] = 0.70, [95% CI, 0.53- 0.93]), and 39% lower for weeks with 3 or more emergency cases (RR = 0.61 [95% CI, 0.53-0.83]), relative to weeks with no emergency cases. Conclusions: When there is an increase in the number of emergency cases, a lower proportion of patients undergo elective surgery within the recommended time. Thus, when performance of surgical servces is evaluated, the probability of patients undergoing elective surgery on time should...


Related Articles

  • Minister solves referral mystery.  // GP: General Practitioner;11/7/2008, p3 

    The article reports that Great Britain health minister Ben Bradshaw has explained that increases in general practitioner (GP) referrals in some parts of England have happened due to falling hospital waiting times. Bradshaw defended extended opening hours because that not only well-off commuters...

  • SUPPLEMENT.  // British Medical Journal (Clinical Research Edition);3/21/1987, Vol. 294 Issue 6574, p783 

    Presents a personal view on the allocation of funds by the Secretary of State Norman Fowler to cut hospital waiting lists in Great Britain. Cooperation between hospitals and general practitioners concerning patient referral; Reference to the study of John Yates on waiting lists; Necessity for...

  • Ca testing bottleneck. Wilkinson, Emma // Pulse;1/26/2006, Vol. 66 Issue 4, p8 

    The article reports on a research on the impact an initiative by the Great Britain National Health Service to increase the proportion of cancer patients general practitioners refer urgently on waiting times for diagnosis or treatment. The study was lead by Celia Ingham Clark, consultant in...

  • Modelamiento y simulación computacional de la red de consultas médicas de un servicio público de salud chileno. Tarride Fernández, Mario Iván; Vásquez, Óscar C.; González Martinic, Julia // Pan American Journal of Public Health;Mar2010, Vol. 27 Issue 3, p203 

    Objective. To create a computerized model and simulation of the patient visit/ referrals process for a health care services organization within Chile's public health care system. Methods. The study was performed with a "system dynamics" focus. Data were collected from the health care service...

  • Factors Related With the Time to Surgery in Waiting-list Patients for Knee Prostheses. Romero Jurado, Manuel; Fidalgo, Alejandro Enrique; Rodríguez Villar, Virginia; Medina, Javier Mar; Soler López, Begoña // Reumatologia Clinica;may/jun2013, Vol. 9 Issue 3, p148 

    Objectives: In the year 2006 the Hospital Complex of Jaén began a new model of attention for consultation of knee osteoarthritis (CMAR), to offer quality treatment to the patient based on clinical practice guidelines. The objective of this study was to analyze the efficiency of the unit, in...

  • Implementation of an intervention plan designed to optimize donor referral in a donor hospital network. Van Gelder, Frank; Van Hees, Dirk; De Roey, Joachim; Monbaliu, Diethard; Aerts, Raymond; Coosemans, Willy; Daenen, Willem; Pirenne, Jacques // Progress in Transplantation;Mar2006, Vol. 16 Issue 1, p49 

    Context--The shortage of donor organs remains the most important factor of waiting list mortality in organ transplantation worldwide. Donor detection is influenced by the legal system, family refusal, and underreporting caused by erroneous knowledge of donation criteria and lack of familiarity...

  • Referrals 'hijacked'. Wilkinson, Emma // Pulse;9/28/2006, Vol. 66 Issue 36, p8 

    The article reports on the diversion of patients away from primary care trusts hospitals to underused independent treatment centers in Great Britain to save money and cut hospital waiting times. This diversion has affected general practitioners (GP) wherein they have reported their referrals are...

  • Frustration continues over wait list returns. Guthrie, Phillip // New Zealand Doctor;6/15/2005, p4 

    Reports on the impact of the referring patients back to surgical waiting lists on general practitioners in New Zealand. Consideration of district health boards (DHB) in treating patients; Implication of the practice for patient welfare; Comments of Chris Fleming, general manager of surgical and...

  • Delays to surgery in non-small-cell lung cancer. Liberman, Moishe; Liberman, Dan; Sampalis, John S.; Mulder, David S. // Canadian Journal of Surgery;Feb2006, Vol. 49 Issue 1, p31 

    Background: In Canada, waiting times for referral and surgery exist for both benign and malignant disease. We attempted to evaluate the length of various waiting times for surgery as well as their association with surgical stage in patients with non-small-cell lung cancer (NSCLC). Methods: This...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics