What is the influence of single-entry models on access to elective surgical procedures? A systematic review
Background Single-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...
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2017-02-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/7/2/e012225.full |
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| author | Deborah A Marshall Zaheed Damani Barbara Conner-Spady Tina Nash Henry Tom Stelfox Tom W Noseworthy |
| author_facet | Deborah A Marshall Zaheed Damani Barbara Conner-Spady Tina Nash Henry Tom Stelfox Tom W Noseworthy |
| author_sort | Deborah A Marshall |
| collection | DOAJ |
| description | Background Single-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).Methods Systematic 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.Results 11 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.Conclusions This 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. |
| format | Article |
| id | doaj-art-e9f824288d7d47a5982fd688f366e5c6 |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2017-02-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-e9f824288d7d47a5982fd688f366e5c62025-02-06T06:15:11ZengBMJ Publishing GroupBMJ Open2044-60552017-02-017210.1136/bmjopen-2016-012225What is the influence of single-entry models on access to elective surgical procedures? A systematic reviewDeborah A Marshall0Zaheed Damani1Barbara Conner-SpadyTina NashHenry Tom StelfoxTom W NoseworthyDepartment of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada1 Community Health Sciences, University of Calgary, Calgary, Alberta, CanadaBackground Single-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).Methods Systematic 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.Results 11 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.Conclusions This 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.https://bmjopen.bmj.com/content/7/2/e012225.full |
| spellingShingle | Deborah A Marshall Zaheed Damani Barbara Conner-Spady Tina Nash Henry Tom Stelfox Tom W Noseworthy What is the influence of single-entry models on access to elective surgical procedures? A systematic review BMJ Open |
| title | What is the influence of single-entry models on access to elective surgical procedures? A systematic review |
| title_full | What is the influence of single-entry models on access to elective surgical procedures? A systematic review |
| title_fullStr | What is the influence of single-entry models on access to elective surgical procedures? A systematic review |
| title_full_unstemmed | What is the influence of single-entry models on access to elective surgical procedures? A systematic review |
| title_short | What is the influence of single-entry models on access to elective surgical procedures? A systematic review |
| title_sort | what is the influence of single entry models on access to elective surgical procedures a systematic review |
| url | https://bmjopen.bmj.com/content/7/2/e012225.full |
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