Abstract
In this paper, we attempt to determine whether delays in scheduling operation affect waiting time in a queue for elective surgery. We analyze the waiting-list management system in a Canadian hospital. We estimate the impact of scheduling delays by modeling access to treatment as a multistate process. We found that patients with any delay in scheduling surgery had longer waiting times than patients without delays. For certain sources of delays, the admission rate was 50–60% lower compared with the rate for admissions without a delay independent of urgency of surgical intervention. Our findings support a concern that waiting time for elective surgery is not simply determined by how many patients are on the waiting list, or by how urgently they need treatment, but also by the waiting list management practice.
Similar content being viewed by others
REFERENCES
C.D. Naylor, A different view of queues in Ontario, Health Affairs 10 (1991) 110–128.
B. Sobolev, P. Brown and D. Zelt, Variation in time spent on the waiting list for elective vascular surgery: a casestudy, Clinical and Investigative Medicine 23 (2000) 227–238.
C. Sanmartin, S.E.D. Shortt, M.L. Barer, S. Sheps, S. Lewis and P.W. McDonald, Waiting for medical services in Canada: lots of heat, but little light, Canadian Medical Association Journal 162 (2000) 1305–1310.
J.I. Williams, T.H. Llewellyn, R. Arshinoff, N. Young and C.D. Naylor, The burden of waiting for hip and knee replacements in Ontario, Journal of Evaluation in Clinical Practice 3 (1997) 59–68.
C.D. Naylor, C.M. Levinton, S. Wheeler and L. Hunter, Queueing for coronarysurgery during severe supply-demand mismatch in a Canadian referral centre: a case study of implicit rationing, Social Science and Medicine 37 (1993) 61–67.
C. DeCoster, K.C. Carriere, S. Peterson, R. Walld and L. Mac William,Waiting times for surgical procedures, Medical Care 37(6 Suppl.) (1999) JS187–JS205.
B. Dowling,Effect of fundholding on waiting times: database study, British Medical Journal 315 (1997) 290–292.
K.A. Clover, T.A. Dobbins, T.J. Smyth and R.W. Sanson-Fisher, Factors associated with waiting time for surgery,Medical Journal of Australia 169 (1998) 464–468.
C.D. Naylor, K. Sykora, S.B. Jaglal and S. Jefferson,Waiting for coronary artery bypass surgery: population-based study of 8517 consecutive patients in Ontario, Canada, Lancet 346 (1995) 1605–1609.
S. Frankel, J. Coast, T. Baker and C. Collins, Booked admissions as areplacement for waiting lists in the new NHS, British Medical Journal 303 (1991) 1257–1258.
S. Lewis, M.L. Barer, C. Sanmartin, S. Sheps, S.E.D. Shortt and P.W. McDonald, Ending waiting-list mismanagement: principles and practice, Canadian Medical Association Journal 162 (2000) 1297–1300.
D.W. Hosmer and S. Lemeshow, Parametric Regression Models, in: Applied Survival Analysis: Regression Modeling of Time to Event Data (Wiley, New York, 1998) Chapter 8.
J.P. Klein, N. Keiding and E.A. Copelan, Plotting summary predictionsin multisurvival models: Probabilities of relapse and death in remission for bone marrow transplantation patients, Statistics in Medicine 12 (1993) 2315–2332.
P.K. Andersen, L.S. Hansen and N. Keiding, Non-and semiparametricestimation of transition probabilities from censored observation of a non-homogeneous Markov process, Scandinavian Journal of Statistics 18 (1991) 153–167.
R.G. Turnbull, B.C. Taylor, Y.N. Hsiang, A.J. Salvian, S. Nanji, G. O'Hanley, D.L. Doyle and P.D. Fry, Assessment of patient waiting times for vascular surgery, Canadian Journal of Surgery 43 (2000) 105–111.
E.M. Guirguis and G.G. Barber, The natural history of abdominal aorticaneurysms, American Journal of Surgery 162 (1991) 481–483.
S. Sarin, D.A. Shields, J. Farrah, J.H. Scurr and P.D. Coleridge-Smith, Does venous function deteriorate in patients waiting for varicose vein surgery?, Journal of Royal Society of Medicine 86 (1993) 21–23.
K. Bull and D.J. Spiegelhalter, Tutorial in biostatistics:Survival analysis in observational studies, Statistics in Medicine 16 (1997) 1041–1074.
J.P. Klein and M.L. Moeschberger, Censoring and truncation, in: Survival Analysis: Techniques for Censored and Truncated Data (Springer, New York, 1997) Chapter 3.
D.W. Hosmer and S. Lemeshow, Descriptive methods for survivaldata, in: Applied Survival Analysis: Regression Modeling of Time to Event Data (Wiley, New York, 1998) Chapter 2.
J.P. Klein and M.L. Moeschberger, Hypothesis testing, in: Survival Analysis: Techniques for Censored andTruncated Data (Springer, New York, 1997) Chapter 7.
D.W. Hosmer and S. Lemeshow, Applied LogisticRegression (Wiley, New York, 1989).
J.P. Pell, A.C.H. Pell, J. Norrie, I. Ford and S.M. Cobbe, Effect ofsocioeconomic deprivation on waiting time for cardiac surgery: retrospective cohort study, British Medical Journal 320 (2000) 15–19.
D.A. Alter, A.S. Basinski, E.A. Cohen and C.D. Naylor, Fairness in the coronary angiographyqueue, Canadian Medical Association Journal 161 (1999) 813–817.
D.A. Alter, A.S. Basinski and C.D. Naylor, A survey of provider experiences and perceptions of preferential access to cardiovascular care in Ontario, Canada, Annals of Internal Medicine 129 (1998) 567–572.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Sobolev, B., Brown, P. & Zelt, D. Modeling and Analysis of Multistate Access to Elective Surgery. Health Care Management Science 4, 125–132 (2001). https://doi.org/10.1023/A:1011457627757
Issue Date:
DOI: https://doi.org/10.1023/A:1011457627757