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| Author | Christopher Deguara |
| Abstract | Appropriate waiting list data collection is vital for the provision and strategic planning of cardiac services. This enables the cardiac team to schedule their work appropriately and to use available resources in the most effective way. In addition to the performance of new cardiological techniques, -2,000 angiograms are performed annually (2002-2005) at the Cardiac Catheterisation Laboratory, SLH. Although this figure is higher than that recommended by the Royal College of Physicians for our population, waiting lists for elective and semi-urgent coronary angiograms exist within the range of 15f8 months and 1.71.9 months respectively. Cardiac Services strategic planning needs to address the ongoing changes of the local population pyramid, which can be the result of the current input into the system, hence inducing a positive feedback effect and increasing the demand. As resources are finite, rationing health care in some form is inevitable. The literature review focuses on various forms of prioritisation/triage with waiting list management systems which facilitate patients care within a clinical appropriate time. Though equity and efficiency are the two most important factors in sustaining a health care system, the provision of the necessary resources to meet the demands is of paramount importance. Methods and Results: Demographic data collection was acquired from SLH CCL database (2004 data, n=2142 - urgent 44%, semi urgent 37%, non-urgent 10% and 9% unspecified.). Calculated waiting time for NECA (n=56) was 158 months, SUCA (n=52) was 4t5 months, NECA<1 yr (n=30) was 2.9t2.2 months and SUCA<1 yr (n=30) was 1.71.9 months. Student t-test showed a significant waiting time difference (p<0.001) between the NECA and SUCA sample population while no significant waiting difference (p values >0.100) was demonstrated between the NECA<1 yr and SUCA<1 yr. ANOVA and Kruskal Wallis tests showed that the patients age (p values 0.3296, 0.0759, 0.2515, 0.1959), locality of residence (p values 0.5094, 0.5863, 0.1547, 0.1045) and gender (p values 0.5733, 0.7177, 0.7828, 0.2378 had no influence on the waiting time between the sample populations. The rate of hospital admission between NECA<1 yr and SUCA<1 yr showed no statistically significant difference. (p value 0.5901). The frequency of patients requiring further treatment post coronary angiography was statistically different between the NECA and SUCA populations while equivocal rates were achieve between the NECA< 1 yr and SUCA< 1 yr(p values 0.04903). Semi-structured interviews were held by a convenient sampling technique with cardiologists, physicians, administrators and CCL multidisciplinary team members. Results showed a high level of awareness amongst interviewees with regards to current mean waiting time and request trends for coronary angiograms. A number of interviewees recommended acceptable waiting times and commented on the relationship with the hospital re-admission rate. Conclusion: Recommended possible solutions include: the initiation of a consultation process with main stakeholders to assess the current and future needs of the local cardiac services: a standard prioritisation system; provisional booking date for semi urgent patients; extension of CCL working hours and workforce planning ; dedicated beds for post-angiogram patient care. The ultimate aim is to ensure an equitable patient centred level of care. |
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| Key words | Non-Urgent, Semi-Urgent, Coronary Angiography, Waiting List, Thesis, Health Services Management |