Rathnayake Dimuthu, Clarke Mike
Center for Public Health, School of Medicine Dentistry and Biomedical Sciences, Queen's University Belfast, Institute of Clinical Science Block A, Royal Victoria Hospital, Grosvenor Road, Belfast, BT12 6BA, UK.
BMC Health Serv Res. 2021 Feb 17;21(1):155. doi: 10.1186/s12913-021-06140-w.
Long waiting times for elective surgery are common to many publicly funded health systems. Inefficiencies in referral systems in high-income countries are more pronounced than lower and middle-income countries. Primary care practitioners play a major role in determining which patients are referred to surgeon and might represent an opportunity to improve this situation. With conventional methods of referrals, surgery clinics are often overcrowded with non-surgical referrals and surgical patients experience longer waiting times as a consequence. Improving the quality of referral communications should lead to more timely access and better cost-effectiveness for elective surgical care. This review summarises the research evidence for effective interventions within the scope of primary-care referral methods in the surgical care pathway that might shorten waiting time for elective surgeries.
We searched PubMed, EMBASE, SCOPUS, Web of Science and Cochrane Library databases in December-2019 to January-2020, for articles published after 2013. Eligibility criteria included major elective surgery lists of adult patients, excluding cancer related surgeries. Both randomised and non-randomised controlled studies were eligible. The quality of evidence was assessed using ROBINS-I, AMSTAR 2 and CASP, as appropriate to the study method used. The review presentation was limited to a narrative synthesis because of heterogeneity. The PROSPERO registration number is CRD42019158455.
The electronic search yielded 7543 records. Finally, nine articles were considered as eligible after deduplication and full article screening. The eligible research varied widely in design, scope, reported outcomes and overall quality, with one randomised trial, two quasi-experimental studies, two longitudinal follow up studies, three systematic reviews and one observational study. All the six original articles were based on referral methods in high-income countries. The included research showed that patient triage and prioritisation at the referral stage improved timely access and increased the number of consultations of surgical patients in clinics.
The available studies included a variety of interventions and were of medium to high quality researches. Managing patient referrals with proper triaging and prioritisation using structured referral formats is likely to be effective in health systems to shorten the waiting times for elective surgeries, specifically in high-income countries.
许多公共资助的卫生系统中，择期手术的等待时间较长是普遍现象。高收入国家转诊系统的效率低下比中低收入国家更为明显。初级保健从业者在决定哪些患者被转诊给外科医生方面起着主要作用，这可能是改善这种情况的一个契机。采用传统的转诊方法时，外科诊所常常挤满了非手术转诊患者，结果手术患者的等待时间更长。改善转诊沟通的质量应能使择期手术护理更及时地得到安排，并提高成本效益。本综述总结了在外科护理路径中初级保健转诊方法范围内可能缩短择期手术等待时间的有效干预措施的研究证据。
我们于2019年12月至2020年1月在PubMed、EMBASE、SCOPUS、Web of Science和Cochrane图书馆数据库中检索2013年以后发表的文章。纳入标准包括成年患者的主要择期手术清单，不包括癌症相关手术。随机对照研究和非随机对照研究均符合要求。根据所使用的研究方法，使用ROBINS-I、AMSTAR 2和CASP评估证据质量。由于存在异质性，综述呈现限于叙述性综合。PROSPERO注册号为CRD42019158455。
电子检索产生了7543条记录。最后，经过去重和全文筛选，九篇文章被认为符合要求。符合要求的研究在设计、范围、报告结果和总体质量上差异很大，包括一项随机试验、两项准实验研究、两项纵向随访研究、三项系统评价和一项观察性研究。所有六篇原创文章均基于高收入国家的转诊方法。纳入的研究表明，在转诊阶段对患者进行分类和优先排序可改善及时就诊情况，并增加手术患者在诊所的会诊次数。
现有研究包括各种干预措施，属于中高质量研究。在卫生系统中使用结构化转诊格式进行适当的分类和优先级管理患者转诊，可能有效地缩短择期手术的等待时间，特别是在高收入国家。
