15 March 2017
Elective surgery waiting lists – what it does and doesn’t tell us about healthcare performance
Each quarter, when BHI publishes Hospital Quarterly, we hear a lot of commentary about waiting lists for elective surgery.
In NSW and across Australia, when a public patient’s elective surgery is booked by a specialist, the patient is placed on a public hospital’s waiting list. The elective surgery is prioritised into three categories depending on how urgent the patient’s need for surgery is:
|Urgency category||Recommended time the surgery is performed within|
On a single day at the end of each quarter, BHI takes a snapshot of waiting list numbers that are published in Hospital Quarterly.
Consider that at the end of the October to December 2016 quarter, there were 73,617 patients on waiting lists for elective surgery in NSW. Of these patients waiting for surgery:
- 17.6% of patients had been added within the last 30 days
- 1.1% of patients were waiting for an urgent surgery; 14.3% were waiting for semi-urgent surgery; and 84.6% were waiting for non-urgent surgery
- Orthopaedic surgery (such as total knee replacements) and ophthalmology (such as cataract extractions) were the specialties with the most patients waiting, making up almost half (49.6%) of patients waiting for elective surgery in public hospitals
- The number of patients on waiting lists increased 0.7% from the same quarter one year earlier.
But what does this tell us about NSW hospital and healthcare performance? The waiting lists give us a rough idea about how much demand there is on the healthcare system and how it is trending. Changes in the size of the waiting list can be influenced by many factors including an increase in population, the ageing of the population and the increase in prevalence of conditions where elective surgery is recognised as an appropriate treatment, as well as the actual number of surgeries performed.
On its own, the number of patients on elective surgery waiting lists does not provide an accurate measure of NSW hospital performance. Waiting lists needs to be considered in the context of other measures of elective surgery performance. That’s why BHI also reports on:
- The number of patients who received elective surgery during a quarter
- How long the patients who received elective surgery waited for it
- How many patients received their surgery within clinically-recommended timeframes.
There is much discussion around the limitations implicit in how waiting lists are reported. To be very clear about this: waiting time data represents a component of the total waiting time for surgery. The time period that we can report on starts from when a patient’s name is added to a hospital’s waiting list and ends when the patient is admitted to hospital to receive that surgery.
Before a patient is added to a waiting list, they first need to be assessed by a surgeon and this can often involve waiting times to get an appointment. The number of people waiting for these sort of appointments is sometimes referred to as the ‘hidden waiting list’ or the ‘waiting list for the waiting list’.
Unfortunately there is no administrative system in Australia that captures data on how many patients are waiting for these appointments, and how long they are waiting for them.
BHI collects information from patients through the NSW Adult Admitted Patient Survey as part of our extensive program seeking feedback from patients about their experiences with healthcare services in NSW. We ask patients how long they waited for their appointment with a specialist and the NSW results for the latest reported year, 2014, are shown below:
|Question or Measure||Respondents||Answer|
|Thinking back to when you first tried to book an appointment with a specialist, how long did you have to wait to see that specialist?||11,198|
What is also important to acknowledge is that, in many instances, the decision to schedule surgery and put a patient on a waiting list is dependent on the clinician taking important factors into account such as the benefits expected for the patient in comparison to the risks that certain procedures entail but also, importantly, the patient’s expectations with regards to the actual timing of the surgery.
In summary, waiting times assist in measuring the rate of turnover on hospital waiting lists and are considered a more reliable indicator of hospital or healthcare system performance than the size of the waiting list. It is also important to take into account whether patients receive surgery within clinical guidelines.
BHI’s patient surveys are an important source of information about performance in NSW and can supplement administrative records, including what patients say about how long they wait before they could see a specialist.
TagsAccessibility and timeliness 4 Ambulance services 2 Appropriateness of healthcare 1 BHI - general 4 Challenging ideas 1 Data 5 Effectiveness of healthcare 2 Efficiency 1 Elective surgery 2 Emergency department 1 Healthcare services 2 Hospital care 3 Patient experience 3 Safety and risk 1
Kim is the Acting Chief Executive of BHI. She has extensive experience in health services research in Australia and internationally.
Jean-Frederic is the Chief Executive of BHI. He is currently on secondment to the Agency for Clinical Innovation.
Hilary is our Director, Strategic Relations. She has extensive experience of developing policy and strategy around the role of information in improving health and healthcare, mostly in the UK.
Renee Carter is a senior analyst at the Bureau of Health Information. She holds a Masters degree in health and social policy from the London School of Economics and a Doctorate in epidemiology from McGill University.