Do case-generic measures of queue performance for bypass surgery accurately reflect the waiting-list experiences of those most urgent?
BACKGROUND
Queue performance is typically assessed using generic measures, which capture the queue in aggregate. The objective of this study was to examine whether case-generic measures of queue performance appropriately reflected the waiting-list experiences of those patients with greatest disease severity.


METHODS
We examined the queue for isolated coronary artery bypass grafting (CABG) in Ontario between April 1993 and March 2000 using data obtained from the Cardiac Care Network. Our primary measure of queue performance was the proportion of patients who received their bypass surgery within their recommended maximum waiting times (%RMWTs) in any given month. We compared case-generic measures of queue performance to case-specific measures of queue performance stratified by urgency level.


RESULTS
The queue was largely comprised of elective cases ranging from 73% (1993) to 57%(1999). Urgent patients comprised the minority of the queue ranging from 14% (1993) to 20% (1999). Case-generic month-to-month variations in the percentage of cases completed within RMWTs (an aggregated waiting list measure encompassing the characteristics of all patients in the queue) closely resembled the experiences of elective patients (R2 = 0.81), but conversely, bore little relationship to the waiting-list experiences of those most urgent (R2 = 0.15).


CONCLUSIONS
Case-generic measures of queue performance for bypass surgery in Ontario were not reflective of the waiting-list experiences of those most urgent. Our results reinforce the concept that urgency-specific waiting list monitoring systems are required to best evaluate and appropriately respond to fluctuations in queue performance.
Burstein
Jason
J
University of Toronto, Toronto, Canada.
Lee
Douglas S
DS
Alter
David A
DA
D001026:Coronary Artery Bypass / Q000706:statistics & numerical data*; D015276:Health Care Rationing / Q000458:organization & administration*; D006801:Humans; D010361:Patients / Q000145:classification; D019984:Quality Indicators, Health Care / Q000458:organization & administration*; D013997:Time Factors; D014850:Waiting Lists