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

This rapid review was conducted as part of the Evidence Service’s collaboration with Heath and Care Research Wales

Next update: Update not planned

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Introduction

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. 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. 

Main points

How up to date is this evidence?

We conducted this rapid review in 2021. Most included studies were published between 2004 and 2017, but one was published in 1991.

What we found

Seventeen 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. 

What this means

Most studies were 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. 

Technical information

Our Rapid Reviews use a variation of the systematic review approach, abbreviating or omitting some components to generate the evidence to inform stakeholders promptly whilst maintaining attention to bias.

Stakeholders

Cwm Taf Health Board