Australia needs to develop ways to improve the quality of data used to measure access to elective surgery and waiting list performance. This is essential for real long term improvements in delivery of elective services, according to an editorial published in the Medical Journal of Australia.
Professor John McNeil, Head of Epidemiology and Preventive Medicine at Monash University, and his co-authors write that elective surgery waiting times should be explicitly defined to provide a valid assessment of the time spent waiting for surgery, and be measured in a standardised way. This should take into account times waited for the primary care and specialist appointments that occur before patients are wait listed.
"Lack of reproducibility, and vulnerability to manipulation, which are characteristics of some of the [current] system's access and performance indicators, limit the value of the information collected," Prof McNeil said. Prof McNeil said decisions about which urgency categories patients should be assigned to were not always consistent and recommended waiting times were not always clinically appropriate.
"While the intensity of clinical symptoms such as pain has been fundamental to assigning urgency categories, doctors vary in how they assess these symptoms," he said.
"In assigning urgency, doctors may consider non-clinical factors, but this occurs informally. Further, each urgency category is aligned with recommended waiting times, which are not evidence-based.
"When a patient is assigned to an urgency category for surgery, there should be an explicit and standardised way of taking into account the need for a procedure.