The cardiac waiting game: are patients prioritized on the basis of clinical need?
Waiting lists for coronary artery bypass grafting (CABG) have been a recurring problem for many hospitals, putting pressure on hospitals to manage waiting lists more effectively. In this study, we audited the records of 1594 patients who had coronary artery bypass surgery in 1992 and 1993 in three London hospitals, to assess their waiting time experience. Patients' actual waiting times were compared with an appropriate waiting time defined using an adapted version of a Canadian urgency scoring system. Influence of other factors (sex, age, smoking, hypertension, diabetes and obesity) on actual waiting time was assessed. A comparison of patients' actual waiting times with an appropriate waiting time, defined by the urgency score, showed that only 38% were treated within the appropriate period. Thirty-four per cent were treated earlier than their ischaemic risk indicated, and 28% with high ischaemic risk were delayed. Actual waiting time was associated with a patient's sex and smoking status but not with the other factors studied. The current system of prioritizing patients awaiting CABG is not concordant with a measure of appropriate waiting time. This could have arisen due to a number of factors, including the contracting process, waiting list initiatives, and methods of waiting list administration and patient pressures. The use of a standard method for prioritizing patients would enable a more appropriate use of resources.
Langham
S
S
Health Services Research Unit, Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, UK.
Soljak
M
M
Keogh
B
B
Gill
M
M
Thorogood
M
M
Normand
C
C
D016507:Cardiology Service, Hospital / Q000592:standards* / Q000706:statistics & numerical data; D001026:Coronary Artery Bypass / Q000706:statistics & numerical data*; D005260:Female; D015276:Health Care Rationing / Q000379:methods*; D006301:Health Services Needs and Demand; D006801:Humans; D008297:Male; D018579:Patient Selection; D010361:Patients / Q000145:classification; D012720:Severity of Illness Index; D013222:State Medicine; D006113:United Kingdom; D014850:Waiting Lists