Hadjistavropoulos H D, Snider B, Bartlett G
Department of Psychology, University of Regina, Saskatchewan, Canada.
Jt Comm J Qual Improv. 1998 Aug;24(8):407-22. doi: 10.1016/s1070-3241(16)30391-1.
Quality of care committees monitor waiting lists to ensure that patient care is not compromised. Frequently, waiting lists are determined by individual physicians, and no explicit criteria determine who is first in the queue. The quality of ophthalmologists' decisions for managing waiting lists of cataract patients, a high-volume elective patient group, was examined in a study of patients undergoing cataract surgery in 1997 in the Regina Health District, Saskatchewan, Canada.
Ninety-eight patients scheduled for surgery were interviewed pre- and postoperatively regarding cataract symptomatology, visual and emotional functioning, coping strategies, and concerns with waiting periods. Ophthalmologists provided preoperative and postoperative information on visual functioning.
Even though no formal criteria guided decision making about how long patients should wait, wait periods conformed to general standards set by consensus of ophthalmologists unless patients decided to delay surgery. Patients voiced little concern about the waiting period, and difficulties with visual and emotional functioning were minimal. Surgery outcomes were not negatively affected by waiting periods, which were in part a function of physician case load but were also related to patient preference and the tendency to seek out reassurance. Visual acuity, cataract symptomatology, and visual functioning were not predictive of waiting time, suggesting that this information is not consistently being used to prioritize patients.
Waiting lists can be well managed by using individual physician decision making, although explicit formal decision-making rules would be helpful. A variety of methodologies and analyses can be used to evaluate the management of waiting lists and to assist in identifying criteria for assigning priority to patients.
医疗质量委员会监测等候名单，以确保患者护理不受影响。通常，等候名单由个别医生确定，且没有明确标准来决定谁排在首位。在对1997年加拿大萨斯喀彻温省里贾纳卫生区接受白内障手术的患者进行的一项研究中，调查了眼科医生管理大量择期患者群体（白内障患者）等候名单的决策质量。
对98名计划接受手术的患者在术前和术后就白内障症状、视觉和情绪功能、应对策略以及对等候时间的担忧进行了访谈。眼科医生提供了术前和术后视觉功能方面的信息。
尽管没有正式标准指导关于患者应等待多长时间的决策，但等候时间符合眼科医生共识制定的一般标准，除非患者决定推迟手术。患者对等候时间几乎没有表示担忧，视觉和情绪功能方面的困难也最小。手术结果并未受到等候时间的负面影响，等候时间部分取决于医生的工作量，但也与患者偏好以及寻求安心的倾向有关。视力、白内障症状和视觉功能并不能预测等候时间，这表明这些信息并未始终被用于确定患者的优先顺序。
尽管明确的正式决策规则会有所帮助，但使用个别医生的决策也可以很好地管理等候名单。可以使用多种方法和分析来评估等候名单的管理，并协助确定为患者分配优先级的标准。
