What is the influence of single-entry models on access to elective surgical procedures? A systematic review

• Published in: BMJ open Vol. 7; no. 2; p. e012225
• Main Authors: Damani, Zaheed, Conner-Spady, Barbara, Nash, Tina, Tom Stelfox, Henry, Noseworthy, Tom W, Marshall, Deborah A
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 01-02-2017; BMJ Publishing Group
• Subjects: Adult; Adults; Design; Efficiency; Efficiency, Organizational; Elective surgery; Elective Surgical Procedures - standards; Evidence-based medicine; Family physicians; Health care access; Health Services Research; Humans; Medical referrals; Models, Organizational; Patient Acceptance of Health Care - statistics & numerical data; Patients; Physicians; Quality; Surgical outcomes; Systematic review; Time management; Waiting Lists; Waiting period; Waiting lists; Health Services Accessibility; Elective Surgical Procedures
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2016-012225

BackgroundSingle-entry models (SEMs) for the management of patients awaiting elective surgical services are designed to increase access and flow through the system of care. We assessed scope of use and influence of SEMs on access (waiting times/throughput) and patient-centredness (patient/provider acceptability).MethodsSystematic review of articles published in 6 relevant electronic databases included studies from database inception to July 2016. Included studies needed to (1) report on the nature of the SEM; (2) specify elective service and (3) address at least 1 of 3 research questions related to (1) scope of use of SEMs; (2) influence on timeliness and access; (3) patient-centredness and acceptability. Article quality was assessed using a modified Downs and Black checklist.Results11 studies from Canada, Australia and the UK were included with mostly weak observational design—2 simulations, 5 before–after, 2 descriptive and 2 cross-sectional studies. 9 studies showed a decrease in patient waiting times; 6 showed that more patients were meeting benchmark waiting times; and 5 demonstrated that waiting lists decreased using an SEM as compared with controls. Patient acceptability was examined in 6 studies, with high levels of satisfaction reported. Acceptability among general practitioners/surgeons was mixed, as reported in 1 study. Research varied widely in design, scope, reported outcomes and overall quality.ConclusionsThis is the first review to assess the influence of SEMs on access to elective surgery for adults. This review demonstrates a potential ability for SEMs to improve timeliness and patient-centredness of elective services; however, the small number of low-quality studies available does not support firm conclusions about the effectiveness of SEMs to improve access. Further evaluation with higher quality designs and rigour is required.