Queueing for coronary surgery during severe supply-demand mismatch in a Canadian referral centre
Subtitle: a case study of implicit rationing
By: C. D. Naylor ... [et al.].
Contributors: Naylor, C. D.; Levinton, C. M.; Wheeler, S.; Hunter, L.; Institute for Clinical Evaluative Sciences in Ontario.
Series: ICES working paper series -- no. 1
Publisher: Institute for Clinical Evaluative Sciences in Ontario
Published: 1993
Place of publication: Ontario
Language: eng
Number of pages: 25
Subjects: Coronary Artery Bypass; Health Care Rationing; Health Services Needs and Demand; Waiting Lists; Health Care Rationing -- economics; Hospitals, Teaching; Referral and Consultation; Retrospective Studies; Humans; Ontario
Description: OBJECTIVES.  To assess how Canadian specialists in a major referral centre managed waiting lists for coronary surgery during a period of unprecedented severe supply-demand mismatch.  DESIGN.  Retrospective structured chart review.  Unselected subjects undergoing coronary angiography in 1987-88 were followed at least one year through medical records and procedure registries to determine if and when they underwent surgery.  SETTING.  Four Toronto teaching hospitals:  three with both angiography and surgery capability; one with angiography alone. PATIENTS.  At least 100 charts from each centre.  From the resulting total of 413 charts, 193 eligible patients went on to surgery.  MAIN OUTCOME MEASURES.  Time from catheterization to surgery in days.  Sites of catheterization and surgery.  Urgency scores for each case as determined from a multifactorial index developed through an expert panel process.  RESULTS.  Waiting time correlated overall with urgency ratings (r = 0.42, p less than 0.0001).  However, inter-hospital differences in mean waiting times ranged up to 8 weeks (p less than 0.0001), and cross-referral to level out discrepancies did not occur.  In the hospital with shortest queues, waiting times were twice as long for patients catheterized off-site versus those referred by on-site cardiologists (p less than 0.0001, after controlling for urgency scores); a similar trend was found in another surgical hospital (p = 0.056).  About half of all patients waited longer than the maximum period recommended by an expert panel.  CONCLUSIONS. Rationing by waiting list partly reflected clinical urgency.  However, explicit queue-forming criteria, audits for institutional bias, and mechanisms to redistribute patients, are necessary to optimize queue-based management of constrained resources.
Notes: February 1993.

Includes bibliographical references. (37 ref.)