WEEK 2: Management of Waiting Lists

Question 1

What is a waiting list?

Answer 1

A list of names of patients who are awaiting admission to hospital (for elective operation) after having been assessed at an outpatient consultation involving a specialist.

In general, the patients are offered places in order in which their names were placed.

Question 2

What is waiting period?

Answer 2

Is the length of time between the name being placed on the list and the patient being admitted.

Question 3

What is the desired average waiting period?

Answer 3

Objective is to have Average Waiting Period -8 weeks.

Question 4

What is waiting time?

Answer 4

Waiting Time - Is the length of time in minutes between a patient is registered at reception on arrival and consultation started.

Question 5

What is the desired average waiting time?

Answer 5

Objective is to have Average Waiting Time - 40 minutes.

Question 6

Outline examples of waiting lists that are kept in Botswana.

Answer 6

Waiting list for having specialist consultation as outpatient.

Waiting list for elective musculoskeletal surgical procedures –interval between recommending surgical procedures and undertaking that intervention

Question 7

Outline Contributory causes to Waiting Lists in Botswana.

Answer 7

*Demand
Internationally musculoskeletal symptoms account for 23% to 27.8 % of primary care and approximately 20% of A&E care.

Primary care providers are exposed to a considerable load of musculoskeletal illness and injury without accessible specialist support.

Competency of primary care providers in musculoskeletal medicine has been challenged.

*Capacity
Orthopedic Surgeons only provide 6% of musculoskeletal care in many developed countries.

-Only three centers for specialist care in Botswana
-Number of Orthopedic specialists – (6) inadequate
-Orthopedic Centers provide coverage to places which are far away

*Access
*Prioritizing

-urgent
disease will continue progressing until diagnosis is established and intervention is made e.g. like bone tumor’s, chronic infections, inflammatory conditions, delayed and malunion of fractures etc.
-Routine
pathology is stable and unlikely to deteriorate fast during the period a person is waiting for surgery.

-Life threatening
Life /limb threatening pathologies are threatening the existence/function of limb or life e.g., fractures, dislocations, acute infections of bone and joints, spinal cord injuries and other acute neurological lesions etc.

Question 8

State the impact of long waiting lists.

Answer 8

Long waiting lists and its impact on
-Quality of life
-Psychosocial health of patients
-Raised anxiety levels
-impact on social activities
-National productivity
-Stressful for family members

Question 9

Outline Recent actions to manage waiting lists.

Answer 9

-Booking System –IPMS –introduced in 2004

-Booking is provided by the specialist

-Reengineering exercise

-Customer satisfaction index & develop strategies to improve satisfaction

-Outreach visits by specialists

-Devolution exercise – clinics and referral hospital

Question 10

Outline Future challenges and the role of doctors in managing them.

Answer 10

1. Musculoskeletal care comes from
   Family Health Practitioners
   Physiotherapist, rehab. assistants etc
   Medical officers, general practitioners
   Paediatricians, Rheumatologists, Physicians
   Increase basic competency in musculoskeletal injury and illness
2. Allocate proportionate time in teaching/training musculoskeletal diseases and injuries
3. Develop more centres of specialised care
4. Increased emphasis on prevention

Question 11

Describe Waiting list for elective musculoskeletal procedures in Botswana.

Answer 11

Load of Musculoskeletal trauma -85%

No uniformity in prioritization or registry

Average waiting list for elective surgical lists is about 6 months

Advancement in surgery on the musculoskeletal diseases and injuries

Many musculoskeletal pathologies are managed on non-operative protocols due to lack of operative time & resources.

Question 12

State Future challenges in the development of musculoskeletal Surgical Services.

Answer 12

1. Training
   Plaster technicians.
   Medical officers in musculoskeletal injuries & diseases
   Specialists & Fellows
2. Managing trauma with 3 tier system
3. Running operating rooms efficiently

4.Improving supply chain of theatre consumable and non-consumable implants, non-drug items and instruments.

5. Developing national centers for specialized services

Question 13

State factors to keep in mind when Developing Services

Answer 13

-Need and evidence based
-Research
-Creating National Data
-Economic impact of musculoskeletal services
-Social impact
-Impact on national productivity
-Long term disability / survival