BMJ 1994;309:593-596 (3 September)

Education and debate

Waiting times: monitoring the total postreferral wait

T Smith 

Tayside Health Board, Dundee DD1 9NL20 Correspondence to: 131 Roundhill Road, St Andrews, Fife, KY16 8HG.

Abstract

Objective : To determine whether the period spent on the true inpatient waiting list is a valid indication of the total time that patients have to wait for an operation; and to assess the feasibility of monitoring the total "postreferral waiting time" by using existing computerised information systems.
Setting : Three randomly selected Scottish hospitals.
Subjects : Waiting list patients admitted to hospital for operations during June to August 1993 in six major specialties, separate attention being focused on cataract operations and hip and knee replacements.
Main outcome measure : The total time that patients have to wait for an operation after the initial general practitioner referral - the postreferral waiting time - compared with that spent at the final stage of the process on the true inpatient waiting list.
Results : In the specialties investigated roughly half (58 days; 53%) of the average postreferral wait of 110 days was spent on the true inpatient waiting list, one third (35 days; 32%) being spent on the outpatient waiting list and one sixth (17 days; 15%) waiting between waiting lists. Only a quarter of cataract patients (73/292) were treated within three months of general practitioner referral compared with over three quarters (228/292) within three months of being placed on the inpatient waiting list. Nevertheless, within a year over 99% of patients (290) had been treated whichever date was taken as the starting point.
Conclusions : Monitoring posterferral waiting times would provide a much more accurate picture for purchasers and patients of waiting times for treatment than is obtained by focusing exclusively on the true inpatient waiting list and facilitate fairer comparisons between NHS trusts in national league tables. Stringent national and local monitoring is essential to ensure (a) that future reductions in the time waiting on true inpatient waiting lists are not gained at the expense of longer periods waiting to be placed on the lists, and (b) that no increases occur in the number of patients placed instead on deferred waiting lists or exempted from the normal maximum waiting time guarantees.

Practice implications

  • Practice implications

  • On average roughly half the time waiting for inpatient treatment is spent waiting on the inpatient waiting list

  • Of the remaining time, one third is spent waiting on the outpatient waiting list and the rest waiting between lists

  • The postreferral waiting time - which refers to the period between referral by the GP to a consultant outpatient clinic and admission for treatment - is a more accurate measure of the waiting time

  • In three Scottish hospitals there was a two-fold variation among consultants in postreferral waiting times for cataract operations and a threefold variation in the time spent waiting on the true inpatient waiting list

  • Careful monitoring is required to ensure that deferred patients are treated as soon as possible after the reason for deferral no longer exists

  • Where guarantee exception codes are employed, as in Scotland, they should be used sparingly


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