Waiting list statistics. I: Relation between admissions from waiting list and length of waiting list.

The relation between changes in inpatient workload, measured as increases or decreases in the number of inpatients admitted from the waiting list, and the overall length of the waiting list was studied. Overall trends in admissions from the waiting list, the influence of seasonal patterns, and the impact of industrial action on admissions were also studied. The hypothesis was that when admissions from the waiting list increased the length of the waiting list would decrease and vice versa. No such simple relation was found. In fact, if anything, as the number of admissions from the waiting list increased so did the length of the waiting list. This result could be due to inconsistencies in compiling waiting list data or to the use of waiting lists to improve organisational efficiency. It is also possible, and perhaps likely, that the ability to meet need in admitting patients to hospital influences patients and their doctors to translate previously unmet need into demand for hospital services.     

Waiting list statistics. III. Comparison of two measures of waiting times.

The length of time that patients spend on waiting lists is a topic of current concern. Calculating the proportion of patients who have been on a waiting list for a long time by taking a census of patients on the list at a single point in time will tend to yield a higher estimate than that obtained by calculating waiting times of patients admitted to hospital during a period of time. To illustrate this point the waiting times of patients in the Oxford region as measured by SBH 203 returns ("census" data) were compared with those as measured by the Hospital Activity Analysis ("event" data). As expected, the SBH 203 census returns showed a higher proportion of patients who had waited over a year compared with the "event" measure of all admissions. This difference, which is analagous to the difference between prevalence and incidence in epidemiology, should be considered when using data from these sources to calculate waiting times.     

Waiting list management in general practice: a review of orthopaedic patients.

OBJECTIVE: To review all patients on a current general practice orthopaedic waiting list for outpatient appointments with regard to accuracy of the list, clinical priority, and need for further radiological investigation before hospital attendance. DESIGN: Record review by one general practitioner and a radiologist, and discussion with patients of management alternatives. SETTING: Six partner city centre urban fund-holding general practice, list size 8651 (29% low deprivation payment status). SUBJECTS: 116 adults on an orthopaedic waiting list. MAIN OUTCOME MEASURES: List accuracy (patient details and status on waiting list); clinical priority (severity of condition); further investigations (results of tests after radiological review). RESULTS: 32 patients (28%) were removed from the waiting list because of inaccuracies. 14 patients were considered to be high priority and referred to other hospitals by utilising waiting list initiative funds. Of these patients, five agreed to referral to another hospital (treatment completed on average within three months of rereferral), six did not wish to be rereferred, and two did not attend to discuss the offer and remained on the original waiting list. One prioritised patient had further radiological investigations, was reassured, and was taken off the waiting list. 10 patients had further investigations. These resulted in six patients being referred to other hospitals, three being taken off the waiting list, and one seeking private care. CONCLUSIONS: Systematic review of patients on an orthopaedic waiting list of one general practice, though time consuming, led to the identification of inaccuracies in the list and changes in management. Costs need further evaluation, but if the findings occur widely substantial benefits could be achieved for patients.     

Waiting list for nursing home admission gives limited insight of the problems. Study in handling of the waiting list and the consequences for the patients

The waiting list for nursing home admission is expected to remain unacceptably long. A study of the use and of possibly problematic consequences of the waiting list was described in a thesis. Despite long mean waiting periods and many problems (depressive symptoms, experiences of burden) already at the start of the waiting period, the majority of the informal caregivers were satisfied with the waiting times. This may be explained by a reticence to nursing home admission and by enlistment to the waiting list "out of precaution". Both a long and a short waiting period could be experienced as too long. Waiting list figures give insufficient insight in the "real" demand for nursing home care and in problematic waiting periods.     

Waiting list for kidney transplant. Some patients wait too long.

The selection of a kidney graft recipient should be made not only taking into account biological and clinical parameters, for assuring the maximum possible clinical success; the ethical objective to allow every patient equal opportunity of receiving a transplant should also be pursued. In every waiting list of transplant candidates a proportion of patients remains in the list for a particularly long time. The present analysis aimed to find out the factors associated with a prolonged waiting time, in order to allow the implementation of patient selection criteria able to balance unfavourable factors. The analysis of the waiting list of our kidney transplant centre allowed to observe that blood group 0, anti-HLA immunisation, presence of rare HLA antigens and, at a lesser extent, HLA homozygosity are associated with a longer waiting time for a kidney transplant.     

Equity of access to renal transplant waiting list and renal transplantation in Scotland: cohort study

Objective To examine the access to the renal transplant waiting list and renal transplantation in Scotland.Design Cohort study.Setting Renal and transplant units in Scotland.Participants 4523 adults starting renal replacement therapy in Scotland between 1 January 1989 and 31 December 1999.Main outcome measures Impact of age, sex, social deprivation, primary renal disease, renal or transplant unit, and geography on access to the waiting list and renal transplantation.Results 1736 of 4523 (38.4%) patients were placed on the waiting list for renal transplantation and 1095 (24.2%) underwent transplantation up to 31 December 2000, the end of the study period. Patients were less likely to be placed on the list if they were female, older, had diabetes, were in a high deprivation category, and were treated in a renal unit in a hospital with no transplant unit. Patients living furthest away from the transplant centre were listed more quickly. The only factors governing access to transplantation once on the list were age, primary renal disease, and year of listing. A significant centre effect was found in access to the waiting list and renal transplantation.Conclusions A major disparity exists in access to the renal transplant waiting list and renal transplantation in Scotland. Comorbidity may be an important factor.     

Waiting times: monitoring the total postreferral wait.

OBJECTIVES--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 postreferral 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.     

Access to adult liver transplantation in Canada: a survey and ethical analysis.

OBJECTIVES: To describe the substantive and procedural criteria used for placing patients on the waiting list for liver transplantation and for allocating available livers to patients on the waiting list; to identify principal decision-makers and the main factors limiting liver transplantation in Canada; and to examine how closely cadaveric liver allocation resembles theoretic models of source allocation. DESIGN: Mailed survey. PARTICIPANTS: Medical directors of all seven Canadian adult liver transplantation centres, or their designates. Six of the questionnaires were completed. OUTCOME MEASURES: Relative importance of substantive and procedural criteria used to place patients in the waiting list for liver transplantation and to allocate available livers. Identification of principal decision-makers and main limiting factors to adult liver transplantation. RESULTS: Alcoholism, drug addiction, HIV positivity, primary liver cancer, noncompliance and hepatitis B were the most important criteria that had a negative influence on decisions to place patients on the waiting list for liver transplantation. Severity of disease and urgency were the most important criteria used for selecting patients on the waiting list for transplantation. Criteria that were inconsistent across the centres included social support (for deciding who is placed on the waiting list) and length of time on the waiting list (for deciding who is selected from the list). Although a variety of people were reported as being involved in these decisions, virtually all were reported to be health to be health care professionals. Thirty-seven patients died while waiting for liver transplantation in 1991; the scarcity of cadaveric livers was the main limiting factor. CONCLUSIONS: Criteria for resource allocation decisions regarding liver transplantation are generally consistent among the centres across Canada, although some important inconsistencies remain. Because patients die while on the waiting list and because the primary limiting factor is organ supply, increased organ acquisition efforts are needed.     

Long distance travel for routine elective surgery: questionnaire survey of patients' attitudes.

OBJECTIVE--To carry out an audit and assess the acceptability of long distance travel to patients on a lengthy surgical waiting list. DESIGN--Audit and questionnaire survey. SETTING--Military hospital in Wiltshire. PATIENTS--116 Patients on a general surgical waiting list at Leighton Hospital near Crewe. INTERVENTIONS--Preselection for medical fitness at a waiting list review clinic. RESULTS--Roughly half of patients offered the facility of travelling 120 miles (190 km) for their routine elective operation at the health authority''s expense accepted. The average waiting list time declared by the patients who travelled was 28 months, and 13 patients stated that their condition prevented them from working. Only four patients regretted their decision to participate in the scheme. Lack of visitors did not cause undue concern. CONCLUSIONS--Some patients did not agree to travel for their operation but almost all of those who did so found the scheme satisfactory. Some minor problems were encountered but these could probably be overcome by ensuring use of appropriate transport, extending the postoperative stay when necessary, and more careful selection of patients for an anaesthetic. For efficient use of theatre time in such schemes it is crucial that the operating consultant surgeon should be in charge of case selection.     

First step in managing bulimia nervosa: controlled trial of therapeutic manual.

OBJECTIVE--To test the short term efficacy of a self directed treatment manual for bulimia nervosa. DESIGN--Randomised controlled trial of the manual against cognitive behavioural therapy and a waiting list. SETTING--Tertiary referral centre. SUBJECTS--81 consecutive referrals presenting with bulimia nervosa or atypical bulimia nervosa. MAIN OUTCOME MEASURES--Frequency of binge eating, vomiting, and other behaviours to control weight as well as abstinence from these behaviours. RESULTS--Cognitive behavioural treatment produced a significant reduction in the frequency of binge eating, vomiting, and other behaviours to control weight. The manual significantly reduced frequency of binge eating and weight control behaviours other than vomiting, and there was no change in the group on the waiting list. Full remission was achieved in five (24%) of the group assigned to cognitive behavioural treatment, nine (22%) of the group who used the manual, and two (11%) of the group on the waiting list. CONCLUSIONS--A self directed treatment manual may be a useful first intervention in the treatment of bulimia nervosa.     

Shortening waiting lists in orthopaedic surgery outpatient clinics.

There is a long waiting list for orthopaedic outpatient appointments in South Glamorgan Area Health Authority as elsewhere. A detailed study of that waiting list was undertaken to identify factors that might lead to its better management and reduction. One-third of patients on the list failed to attend when appointments were offered. A postal-questionnaire to all those listed as waiting confirmed that many no longer sought specialist orthopaedic consultation. Another third of the patients reported that they had been treated previously for the same orthopaedic problem. It is concluded that improved management of long outpatient waiting lists could be achieved by correspondence with referring general practitioners to weed out those patients who no longer wish to attend, to reduce the burden of reviews and re-referrals of patients with "chronic" conditions, and to request priorities fairly so that earlier appointments may be offered to truly "new" patients with treatable or with potentially serious conditions.     

Annotated list of fish-like vertebrates and fish of the Kara Sea

Based on literature and new actual data from 2007–2012, a revised list of fish species inhabiting the Kara Sea is given. The modern ichthyofauna of the Kara Sea comprises 77 species of marine, anadromous, and freshwater fish from 24 families of 14 orders. For the first time, 12 fish species are indicated for this region.     

Influence of Socio-Economic Inequalities on Access to Renal Transplantation and Survival of Patients with End-Stage Renal Disease

BackgroundPublic and scientific concerns about the social gradient of end-stage renal disease and access to renal replacement therapies are increasing. This study investigated the influence of social inequalities on the (i) access to renal transplant waiting list, (ii) access to renal transplantation and (iii) patients’ survival.MethodsAll incident adult patients with end-stage renal disease who lived in Bretagne, a French region, and started dialysis during the 2004–2009 period were geocoded in census-blocks. To each census-block was assigned a level of neighborhood deprivation and a degree of urbanization. Cox proportional hazards models were used to identify factors associated with each study outcome.ResultsPatients living in neighborhoods with low level of deprivation had more chance to be placed on the waiting list and less risk of death (HR = 1.40 95%CI: [1.1–1.7]; HR = 0.82 95%CI: [0.7–0.98]), but this association did not remain after adjustment for the patients’ clinical features. The likelihood of receiving renal transplantation after being waitlisted was not associated with neighborhood deprivation in univariate and multivariate analyses.ConclusionsIn a mixed rural and urban French region, patients living in deprived or advantaged neighborhoods had the same chance to be placed on the waiting list and to undergo renal transplantation. They also showed the same mortality risk, when their clinical features were taken into account.     

How much day surgery? Delphic predictions.

A list was compiled of 83 of the commonest operations, which according to published reports may be performed on day patients but which in our district were usually performed on inpatients. The results of a national Delphi study among anaesthetists and general surgeons who were known to be in favour of day surgery produced estimates of the probable rates of day surgery for each of those operations under ideal conditions. Comparison of these figures with those from a Delphi study carried out in one district and with figures for day surgery carried out in that district and with waiting list figures enabled two health districts to focus their efforts to increase day surgery. The figures from the national Delphi study could be applied in other districts if the following are taken into account: Hospital Activity Analysis data must be validated; though there was consensus among the national Delphi consultants, personal clinical opinions varied; the case load may grow as waiting lists decrease.     

Effect on prescribing of the limited list in a computerised group practice.

The prescribing of drugs in the therapeutic classes that are affected by the government''s limited list was investigated in a computerised group practice of just over 3,000 patients. Prescribable drugs in categories that are affected by the list were identified for two consecutive six month periods before and one six month period after the introduction of the list. A significant decrease in the prescribing of cough and cold remedies, vitamins, and antacids occurred after the list was introduced, whereas no change occurred in the prescribing of laxatives, benzodiazepines, or analgesics. The prescribing of iron and penicillin increased significantly after the list was introduced, whereas the use of H2 antagonists and non-steroidal anti-inflammatory drugs showed no significant change.     

Estimating list inflation in a practice register.

The reason why patients were incorrectly registered in an age-sex register was studied. Whereas underregistration was caused by patient delay in registering with a doctor, the much greater number of overregistered patients were thought to be there largely because of administrative delays in removing their names from the register. It is suggested that it would be possible for the software of a computer system in general practice to correct the population size and structure for estimated list inflation.     

A quality improvement program to reduce the time on the lung transplant waiting list at the Nantes University Hospital

Background

In 2010, the time on the lung transplant waiting list in Nantes University Hospital (NUH) was 9.2 months, compared to a French national median of about 4 months. The NUH transplant unit performs both heart and lung transplantations, which can be seen as competing activities. To fix the problem, the adult Cystic Fibrosis (CF) team decided to engage in the French CF Quality Improvement Program (QIP PHARE-M) in 2012. The objectives were: i) To reduce the time on the lung transplant waiting list at the Nantes Transplant Unit by increasing the number of lung transplants per year twhile maintaining a 5-year survival rate above the French national average. ii) To improve the organization of the lung transplant access process and the quality of the waiting time for patients.

Methods

A quality controller was involved as the QIP referent to coach the CF quality team, analyze the pre-transplant process, and set up meaningful measures. Benchmarking was performed with other transplant units, and staff discussions were held with the Transplant Team (TT) to assess the outcomes of rejected donor lungs. Negotiations were made with the hospital administration. Plan, Do, Study and Act cycles were used to redesign the pre-transplant assessment in connection with the CF centers (CFC) referring patients to the NUH transplant unit.

Results

i) The flow of patients has been reorganized, decreasing the time spent in surgical intensive care by increasing the number of beds in the intensive care unit, and a chest physician has been recruited ii) The number of organs rejected has been reduced iii) Lung transplant activity has increased to 20–25 transplants per year, and the median waiting time was reduced to 3.5 months for patients transplanted in 2014 and to 1.85 months for patients transplanted in 2015 iv) Added-value activities including education, information, and psychosocial support are now offered to patients during the waiting time.

Conclusion

The QIP PHARE-M, including coaching by a quality-engineer, has helped our adult CF center address its specific lung transplant issues and redesign the lung transplant process for both local patients and patients referred by other CFC.

     

Making Hospital Geriatrics Work

The first year''s work at a new geriatric department at Northwick Park Hospital shows that active policies revolutionize the geriatric service and result in high turnover of patients and no waiting list. Comparison with low turnover/waiting list departments shows the effects of a waiting list in terms of diminished therapeutic benefit and less favourable outcome for patients admitted. The requirements for elimination of the waiting list appear to be well directed policies and adequate and enthusiastic staff. Active geriatrics results in high morale and could be widely applicable within the present hospital bed resources given the necessary improvements in staffing.     

A preliminary list of the Muscidae (Diptera) of the Magadan region,Russia

A preliminary list is given of the species of the Muscidae (Diptera) of the Magadan region, including 93 species in 23 genera. Eighty-one species are newly recorded from this territory. Six species [Spilogona aenea Huckett, 1965, S. bifimbriata Huckett, 1965, S. fulvibasis Huckett, 1965, S. incerta Huckett, 1965, S. separata Huckett, 1965, S. trigonifera (Zetterstedt, 1838)] are newly recorded for Russia. All these species, except Spilogona trigonifera, are newly recorded for the Palaearctic region. The species list includes the material examined, ecological data of some species, the distribution and all known references to each species. According to preliminary estimates, this list reflects 60% of expected species in the Magadan region. Two new synonyms are proposed: Coenosia shumshuensis Shinonaga & Zhang, 2000, n. syn. for C. alaskensis Huckett, 1965, and Coenosia remissa Huckett, 1965, n. syn. for C. ciliata Hennig 1961.