The effectiveness of service delivery interventions for adult orthopaedic patients on a surgical waiting list

What approaches can be used to reduce waiting times for orthopaedic surgery?

Planned hospital surgery has been badly affected worldwide by the COVID-19 pandemic.  By August 2021 waiting lists in Wales had increased to 657,539.  The public and the NHS are very concerned about lengthening waiting times for non-urgent surgery.  This research looks at ways of increasing efficiency of the service to help reduce the backlog for adults on a waiting list for orthopaedic operations. 

17 studies using three main approaches were selected in a range of countries.  The studies looked at a range of surgical procedures and ranged from 42 to 12,030 patients taking part. The three different approaches were: 

• Using established methods* to improve efficiency 

• Redesigning the patient pathway 

• Allocating more resources 

The results were examined to compare waiting times, how often the surgical procedures were performed, cancellation rates of operations and numbers of operations performed.   

The results from these studies suggested that performance could be improved in all cases.  

Changes introduced resulted in operating theatres working more efficiently. Waiting times and turnaround times decreased.  Patient satisfaction and acceptability of waiting times were also found to increase in some studies. 

Most studies were published between 2004 and 2017, so were all carried out before the pandemic started.  There were also limitations in how the studies were carried out which made it difficult to know how reliable the results are.  It is not known whether new methods introduced as a result of these studies will be successful during or after the pandemic. 

However, it is felt that lessons can still be learnt from these studies and applied to the current situation, but this will involve- 

• Accepting that the solution to reduce the backlog will need a team effort with many different strands working together and which takes the local situation into account. 

• Considering all the approaches used in these studies to improve waiting times 

• Further research and evaluation into how these strategies might work in the pandemic situation in order to plan for the future. 

*Lean: staff work together to identify what really matters to the patient and cut out any activities that are not important. 

Six Sigma:  uses detailed information to ensure processes are controlled and consistent. 

Read the full report.